Provider Demographics
NPI:1619788569
Name:ARCHER, LISA (BC-MH, CCH, FMCHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:BC-MH, CCH, FMCHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 RAIN SONG
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4998
Mailing Address - Country:US
Mailing Address - Phone:512-924-5979
Mailing Address - Fax:
Practice Address - Street 1:2724 RAIN SONG
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4998
Practice Address - Country:US
Practice Address - Phone:512-924-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist