Provider Demographics
NPI:1760510556
Name:SWEATT, LISA INEZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:INEZ
Last Name:SWEATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-2225
Mailing Address - Country:US
Mailing Address - Phone:805-756-6123
Mailing Address - Fax:805-756-1134
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:CAL POLY STATE UNIV.,PSYCHOLOGY & CHILD DEV. DEPARTMENT
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407-9000
Practice Address - Country:US
Practice Address - Phone:805-756-6123
Practice Address - Fax:805-756-1134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19226103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent