Provider Demographics
NPI:1649980186
Name:TRIHUS, LISA JOY (LMSW)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:JOY
Last Name:TRIHUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 WASHER AVE # A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3411
Mailing Address - Country:US
Mailing Address - Phone:817-805-9588
Mailing Address - Fax:
Practice Address - Street 1:405 AIRPORT FWY STE 508
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5358
Practice Address - Country:US
Practice Address - Phone:682-445-0431
Practice Address - Fax:214-594-9850
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069051041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool