Provider Demographics
NPI:1871982132
Name:GOOLSBY, LISA KAYE (MSW, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAYE
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:MSW, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4760
Mailing Address - Country:US
Mailing Address - Phone:314-414-0226
Mailing Address - Fax:888-507-4453
Practice Address - Street 1:1810 CRAIG RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4760
Practice Address - Country:US
Practice Address - Phone:314-414-0226
Practice Address - Fax:888-507-4453
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024480103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst