Provider Demographics
NPI:1841852621
Name:BAYES, LISA MARLENE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARLENE
Last Name:BAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6232
Mailing Address - Country:US
Mailing Address - Phone:208-734-0407
Mailing Address - Fax:208-734-3534
Practice Address - Street 1:264 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6232
Practice Address - Country:US
Practice Address - Phone:208-734-0407
Practice Address - Fax:208-734-3534
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC7375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-7375OtherLICENSE