Provider Demographics
NPI:1942075007
Name:HARRISON, LISA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 JOHNSTON ST APT 8-2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3205
Mailing Address - Country:US
Mailing Address - Phone:337-371-9452
Mailing Address - Fax:
Practice Address - Street 1:4023 AMBASSADOR CAFFERY PKWY STE 507
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5268
Practice Address - Country:US
Practice Address - Phone:337-284-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health