Provider Demographics
NPI:1588383921
Name:URBINA, LISA KATHLEEN (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KATHLEEN
Last Name:URBINA
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N MILSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6656
Mailing Address - Country:US
Mailing Address - Phone:316-305-3366
Mailing Address - Fax:
Practice Address - Street 1:707 N MILSTEAD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6656
Practice Address - Country:US
Practice Address - Phone:316-305-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool