Provider Demographics
NPI:1316071152
Name:MOWREY, LISA L (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:MOWREY
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 MIDNIGHT PASS RD # 11E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-8707
Mailing Address - Country:US
Mailing Address - Phone:941-544-3900
Mailing Address - Fax:
Practice Address - Street 1:1532 STICKNEY POINT RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3718
Practice Address - Country:US
Practice Address - Phone:941-544-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health