Provider Demographics
NPI:1548464209
Name:JAMES, LISA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:JAMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 133
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-1583
Mailing Address - Country:US
Mailing Address - Phone:816-721-4652
Mailing Address - Fax:816-930-2162
Practice Address - Street 1:108 S THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-2124
Practice Address - Country:US
Practice Address - Phone:816-721-4652
Practice Address - Fax:816-930-2162
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040238851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496155102Medicaid
MOP00677208OtherMEDICARE RAILROAD
MOMA1279Medicare UPIN