Provider Demographics
NPI:1790866366
Name:DAY, LISA A (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:DAY
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4975
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-4975
Mailing Address - Country:US
Mailing Address - Phone:208-720-9342
Mailing Address - Fax:208-726-6467
Practice Address - Street 1:180 1ST ST W
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-0100
Practice Address - Country:US
Practice Address - Phone:208-720-9342
Practice Address - Fax:208-726-6467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical