Active NPI
Lisa Utterback
- Peer Specialist
- Deer Park, TX
National Provider Identifier
1326732066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1783-0523
- Practice address
- 4525 Glenwood Ave
Deer Park, TX 77536-7901 - Phone
- (281) 476-0088
- NPI assigned
- Jun 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 1783-0523 | TX | Primary |
Addresses
Primary practice location
4525 Glenwood Ave
Deer Park, TX 77536-7901
Mailing address
4525 Glenwood Ave
Deer Park, TX 77536-7901
Phone (281) 476-0088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1783-0523 | TX | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1326732066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4525 GLENWOOD AVE",
"city": "DEER PARK",
"state": "TX",
"postal_code": "775367901",
"telephone_number": "281-476-0088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4525 GLENWOOD AVE",
"city": "DEER PARK",
"state": "TX",
"postal_code": "775367901",
"telephone_number": "281-476-0088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UTTERBACK",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-06",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "TX",
"license": "1783-0523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.