Provider Demographics
NPI:1831887892
Name:CRIST, LISA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:CRIST
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 1:101 W SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4753
Mailing Address - Country:US
Mailing Address - Phone:623-261-2983
Mailing Address - Fax:
Practice Address - Street 1:8765 W KELTON LN BLDG A2B3
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3584
Practice Address - Country:US
Practice Address - Phone:602-613-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-211701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical