Provider Demographics
NPI:1215100797
Name:BLOSSER, LISA K (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 HAMPTON CTR STE H
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0645
Mailing Address - Country:US
Mailing Address - Phone:304-405-6810
Mailing Address - Fax:304-599-2705
Practice Address - Street 1:7000 HAMPTON CTR STE H
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0645
Practice Address - Country:US
Practice Address - Phone:304-405-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical