Provider Demographics
NPI:1205627767
Name:MAC LEAN, LISA-MARIE (LMFT-A)
Entity type:Individual
Prefix:
First Name:LISA-MARIE
Middle Name:
Last Name:MAC LEAN
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 ROUNTREE RANCH LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4826
Mailing Address - Country:US
Mailing Address - Phone:512-920-8265
Mailing Address - Fax:
Practice Address - Street 1:505 E HUNTLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3741
Practice Address - Country:US
Practice Address - Phone:512-201-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist