Provider Demographics
NPI:1760621262
Name:THOMAN, LISA VINUESA (MA,PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VINUESA
Last Name:THOMAN
Suffix:
Gender:F
Credentials:MA,PHD
Other - Prefix:MS
Other - First Name:LISA/ELISA
Other - Middle Name:MARGARITA
Other - Last Name:VINUESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,PHD
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:CRU (8C)
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-1014
Mailing Address - Fax:214-302-1414
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:CRU (8C)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1014
Practice Address - Fax:214-302-1414
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14619101YP2500X
TX33127103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical