Provider Demographics
NPI:1871852657
Name:PALLMEYER, LISA STANTON (MA, LPC-S, LSSP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:STANTON
Last Name:PALLMEYER
Suffix:
Gender:F
Credentials:MA, LPC-S, LSSP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 EASTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5603
Mailing Address - Country:US
Mailing Address - Phone:512-940-6506
Mailing Address - Fax:
Practice Address - Street 1:925 WESTBANK DR
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6623
Practice Address - Country:US
Practice Address - Phone:512-904-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65257101YP2500X
TX33446103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool