Provider Demographics
NPI:1811257264
Name:OUTHIER, LISA ELDER (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELDER
Last Name:OUTHIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N 16TH ST
Mailing Address - Street 2:C-200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5237
Mailing Address - Country:US
Mailing Address - Phone:602-795-1670
Mailing Address - Fax:602-795-1699
Practice Address - Street 1:7330 N 16TH ST
Practice Address - Street 2:C-200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5237
Practice Address - Country:US
Practice Address - Phone:602-795-1670
Practice Address - Fax:602-795-1699
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3909103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent