Provider Demographics
NPI:1205667482
Name:POLANCO, LISA ANN (LPC-A)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:POLANCO
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 RIO CACTUS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2615
Mailing Address - Country:US
Mailing Address - Phone:210-846-6163
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 690864
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78269-0864
Practice Address - Country:US
Practice Address - Phone:210-744-5863
Practice Address - Fax:210-479-1959
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional