Provider Demographics
NPI:1679361596
Name:LIFTO, LOIS
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:LIFTO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8297
Mailing Address - Country:US
Mailing Address - Phone:214-690-1509
Mailing Address - Fax:214-690-1509
Practice Address - Street 1:2052 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-8297
Practice Address - Country:US
Practice Address - Phone:214-690-1509
Practice Address - Fax:214-690-1509
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health