Provider Demographics
NPI:1538552765
Name:WOLFE, LISA E
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 NE HWY 20
Mailing Address - Street 2:CHILDRENS FARM HOME
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1826
Mailing Address - Country:US
Mailing Address - Phone:541-758-5979
Mailing Address - Fax:
Practice Address - Street 1:4455 NE HWY 20
Practice Address - Street 2:CHILDRENS FARM HOME
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1826
Practice Address - Country:US
Practice Address - Phone:541-758-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor