Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LISAC15071 | AZ |
Y | 101YP2500X | Professional Counselor | LPC-16719 | AZ |
NPI | 1003339631 |
---|---|
Provider Name | Lisa Oddo Barras |
First Address | Chandler, AZ 85224-6162 |
Second Address | Chandler, AZ 85224-6162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 07/08/2020 |