Provider Demographics
NPI:1225903099
Name:THAI, LISA (MFTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THAI
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 E 18TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4081
Mailing Address - Country:US
Mailing Address - Phone:541-321-6137
Mailing Address - Fax:541-833-4033
Practice Address - Street 1:74 E 18TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4081
Practice Address - Country:US
Practice Address - Phone:541-833-0205
Practice Address - Fax:541-833-4033
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR12042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health