Provider Demographics
NPI:1922109347
Name:SCHAMPAN, LISA JAMESON (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JAMESON
Last Name:SCHAMPAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:JAQUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1700 ALMA DR
Mailing Address - Street 2:STE. 315
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6937
Mailing Address - Country:US
Mailing Address - Phone:972-994-1175
Mailing Address - Fax:972-509-9062
Practice Address - Street 1:1700 ALMA DR
Practice Address - Street 2:STE. 315
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6937
Practice Address - Country:US
Practice Address - Phone:972-994-1175
Practice Address - Fax:972-509-9062
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00235EMedicare ID - Type Unspecified