Provider Demographics
NPI:1134366974
Name:MENNET, LISA ANN (MED)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MENNET
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3505
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-3505
Mailing Address - Country:US
Mailing Address - Phone:206-419-9428
Mailing Address - Fax:
Practice Address - Street 1:6250 LAKE SHORE DR S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3040
Practice Address - Country:US
Practice Address - Phone:206-419-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00036070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health