Provider Demographics
NPI:1215161518
Name:CRENSHAW, LISA S (LCP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1201
Mailing Address - Country:US
Mailing Address - Phone:316-522-1444
Mailing Address - Fax:316-361-0679
Practice Address - Street 1:301 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1201
Practice Address - Country:US
Practice Address - Phone:316-522-1444
Practice Address - Fax:316-361-0679
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP 116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist