Provider Demographics
NPI:1942263298
Name:ESTELLE, LISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ESTELLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 N DIVISION ST STE 100
Mailing Address - Street 2:SPOKANE
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2321
Mailing Address - Country:US
Mailing Address - Phone:509-467-9111
Mailing Address - Fax:509-468-1294
Practice Address - Street 1:10103 N DIVISION ST STE 100
Practice Address - Street 2:SPOKANE
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2321
Practice Address - Country:US
Practice Address - Phone:509-467-9111
Practice Address - Fax:509-468-1294
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical