Provider Demographics
NPI:1700300928
Name:ANSELMOMARNACH, LISA (PHD, LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANSELMOMARNACH
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ANSELMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11212 N CALISPEL CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2585
Mailing Address - Country:US
Mailing Address - Phone:509-847-5437
Mailing Address - Fax:509-691-4367
Practice Address - Street 1:11212 N CALISPEL CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2585
Practice Address - Country:US
Practice Address - Phone:509-847-5437
Practice Address - Fax:509-691-4367
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60680484103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist