Provider Demographics
NPI:1629880083
Name:COUFAL, LISA KAY
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:COUFAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:COUFAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11251 HIGHWAY 36 N
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6370
Mailing Address - Country:US
Mailing Address - Phone:979-451-0943
Mailing Address - Fax:
Practice Address - Street 1:304 KERR ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3838
Practice Address - Country:US
Practice Address - Phone:979-451-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist