Provider Demographics
NPI:1770960924
Name:RODDY, LISA D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:RODDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 TAMACE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6601
Mailing Address - Country:US
Mailing Address - Phone:405-413-6603
Mailing Address - Fax:
Practice Address - Street 1:13001 TAMACE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6601
Practice Address - Country:US
Practice Address - Phone:405-413-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist