Provider Demographics
NPI:1891269213
Name:SHENK, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD STE 108A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7183
Mailing Address - Country:US
Mailing Address - Phone:512-773-2924
Mailing Address - Fax:
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7183
Practice Address - Country:US
Practice Address - Phone:512-773-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional