Provider Demographics
NPI:1770192775
Name:GHILONI, LISA (PHD, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:GHILONI
Suffix:
Gender:F
Credentials:PHD, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BONAVENTURE WAY STE 126
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8006
Mailing Address - Country:US
Mailing Address - Phone:832-429-7307
Mailing Address - Fax:
Practice Address - Street 1:800 BONAVENTURE WAY STE 126
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8006
Practice Address - Country:US
Practice Address - Phone:832-429-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031772363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty