Provider Demographics
NPI:1801908413
Name:SCHIMMEL, LISA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:SCHIMMEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1631 NE BROADWAY ST
Mailing Address - Street 2:PMB 738
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1425
Mailing Address - Country:US
Mailing Address - Phone:503-381-9524
Mailing Address - Fax:855-714-4323
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:SUITE 619
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:503-381-9524
Practice Address - Fax:855-714-4323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 15072103TC0700X
OR1709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL150720OtherBLUESHIELD OF CALIFORNIA
CA178132OtherMHN
CAPSY 15072OtherMEDI-CAL PROVIDER NUMBER
CA178132OtherMHN
CAPSY 15072OtherMEDI-CAL PROVIDER NUMBER