Provider Demographics
NPI:1871353417
Name:DANIEL, LISA MARIE (LPC, LSSP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LPC, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 BLACKJACK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-8296
Mailing Address - Country:US
Mailing Address - Phone:903-268-9958
Mailing Address - Fax:
Practice Address - Street 1:3831 BLACKJACK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-8296
Practice Address - Country:US
Practice Address - Phone:903-268-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32985103TS0200X
TX86674101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool