Lisa A Davisson

Individual provider Active NPI Mental Health Counselor · Selah, WA

NPI 1588096192 · NPPES record last updated Mar 28, 2016

Key facts

NPI
1588096192
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
CO60214519 (WA)
Practice address
1390 Jesica Dr
Selah, WA 98942-1728
Phone
(509) 697-9891
NPI assigned
Aug 6, 2013
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CO60214519WAMDMental Health Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CO60214519 WA Yes

Addresses

Primary practice location

1390 Jesica Dr
Selah, WA 98942-1728

Mailing address

1390 Jesica Dr
Selah, WA 98942-1728
Phone (509) 697-9891

Other providers in Selah, WA

All providers in Selah, WA · Mental Health Counselor in Washington

Sources for this page

Verify at the official NPI Registry.