Provider Demographics
NPI:1609417740
Name:KIERAN, LISA SUMITRA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUMITRA
Last Name:KIERAN
Suffix:
Gender:F
Credentials:
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 5161
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85703-0161
Mailing Address - Country:US
Mailing Address - Phone:360-287-4847
Mailing Address - Fax:562-583-0580
Practice Address - Street 1:166 E LIMBERLOST DR UNIT 102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-8816
Practice Address - Country:US
Practice Address - Phone:360-287-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61249712101YM0800X
AZLPC-23526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health