Provider Demographics
NPI:1770322612
Name:FORGER, LISA MIRANDA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MIRANDA
Last Name:FORGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 RICHMOND AVE APT 2416
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3632
Mailing Address - Country:US
Mailing Address - Phone:713-377-1083
Mailing Address - Fax:
Practice Address - Street 1:108 WILD BASIN RD STE 250
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-3468
Practice Address - Country:US
Practice Address - Phone:713-377-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional