Provider Demographics
NPI:1013056696
Name:GOLD, LISA LOREE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOREE
Last Name:GOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 E BROWN RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4954
Mailing Address - Country:US
Mailing Address - Phone:602-550-9393
Mailing Address - Fax:
Practice Address - Street 1:6106 E BROWN RD
Practice Address - Street 2:SUITE #102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4954
Practice Address - Country:US
Practice Address - Phone:602-550-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10628101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor