Basic Information
| Provider Information | |||||||||
| NPI: | 1588075493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCVANN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 E IDAHO AVE | ||||||||
| Address2: | SUITE 2-E | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755569585 | ||||||||
| FaxNumber: | 5755569456 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 E IDAHO AVE | ||||||||
| Address2: | SUITE 2-E | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755569585 | ||||||||
| FaxNumber: | 5755569456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0165161 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.