Provider Demographics
NPI:1932241395
Name:ROBERTS, LISA NORTHCUTT (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NORTHCUTT
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC
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 1
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:76455-0001
Mailing Address - Country:US
Mailing Address - Phone:325-667-0037
Mailing Address - Fax:325-667-0047
Practice Address - Street 1:206 E. MAIN
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:TX
Practice Address - Zip Code:76455
Practice Address - Country:US
Practice Address - Phone:325-667-0037
Practice Address - Fax:325-667-0047
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health