Provider Demographics
NPI:1942595848
Name:POWELL, LISA ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 W WACO DR STE 5
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5353
Mailing Address - Country:US
Mailing Address - Phone:254-235-6542
Mailing Address - Fax:254-235-6254
Practice Address - Street 1:3708 W WACO DR STE 5
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5353
Practice Address - Country:US
Practice Address - Phone:254-235-6542
Practice Address - Fax:254-235-6254
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional