Provider Demographics
NPI:1588271662
Name:TERWILLIGER, LISA KAYE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAYE
Last Name:TERWILLIGER
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 1:1917 ABBOTT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3449
Mailing Address - Country:US
Mailing Address - Phone:907-802-2493
Mailing Address - Fax:202-931-0745
Practice Address - Street 1:1917 ABBOTT RD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3449
Practice Address - Country:US
Practice Address - Phone:907-802-2493
Practice Address - Fax:202-931-0745
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1634101YP2500X
AK358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional