Provider Demographics
NPI:1386811651
Name:WAID-MCKENNA, LISA (PHD, LPC-S)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:WAID-MCKENNA
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 CHALKSTONE COVE
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5431
Mailing Address - Country:US
Mailing Address - Phone:940-765-8555
Mailing Address - Fax:
Practice Address - Street 1:3310 CHALKSTONE COVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5431
Practice Address - Country:US
Practice Address - Phone:940-765-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63627101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor