Provider Demographics
NPI:1992397806
Name:MCCAY, LISA K
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:MCCAY
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 1:1305 BERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1404
Mailing Address - Country:US
Mailing Address - Phone:952-250-6528
Mailing Address - Fax:
Practice Address - Street 1:1305 BERRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1404
Practice Address - Country:US
Practice Address - Phone:952-250-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health