Provider Demographics
NPI:1841360344
Name:WETZEL, LISA LEE (MS, MFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:LEE
Other - Last Name:FROISTAD-CLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:7331 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1513
Mailing Address - Country:US
Mailing Address - Phone:702-650-6200
Mailing Address - Fax:844-701-4697
Practice Address - Street 1:7331 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1513
Practice Address - Country:US
Practice Address - Phone:702-650-6200
Practice Address - Fax:844-701-4697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist