Provider Demographics
NPI:1952076960
Name:MATHIS, LISA DARLENE (BS, QMHP, MSW STUDEN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DARLENE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:BS, QMHP, MSW STUDEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8994
Mailing Address - Country:US
Mailing Address - Phone:541-815-6533
Mailing Address - Fax:
Practice Address - Street 1:1470 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1366
Practice Address - Country:US
Practice Address - Phone:541-316-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker