Provider Demographics
NPI:1871932012
Name:SCHMIDT, LISA R (MS, LPC, CN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS, LPC, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 E SHEA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6986
Mailing Address - Country:US
Mailing Address - Phone:480-675-4568
Mailing Address - Fax:480-907-1963
Practice Address - Street 1:9375 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6986
Practice Address - Country:US
Practice Address - Phone:480-675-4568
Practice Address - Fax:480-907-1963
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20358101YM0800X
133NN1002X
AZ0199991212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20358OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH LICENSE LPC
WANU60495044OtherCERTIFIED NUTRITIONIST