Provider Demographics
NPI:1457360778
Name:FARIAS, LISA ANN (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:FARIAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 MAYTUM CIR
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3601
Mailing Address - Country:US
Mailing Address - Phone:210-560-7200
Mailing Address - Fax:210-888-3816
Practice Address - Street 1:9710 MAYTUM CIR
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3601
Practice Address - Country:US
Practice Address - Phone:210-560-7200
Practice Address - Fax:210-888-3816
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162156701Medicaid