Provider Demographics
NPI:1851457154
Name:RASMUSSEN, LISA D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3942
Mailing Address - Country:US
Mailing Address - Phone:713-818-6786
Mailing Address - Fax:
Practice Address - Street 1:1502 SAWYER ST STE 234
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-4446
Practice Address - Country:US
Practice Address - Phone:281-783-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7412103TC0700X
TX36870103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90020OtherBLUE CROSS PROVIDER NUMBE