Provider Demographics
NPI:1588897714
Name:EGAN, LISA M (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DIAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1809 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8507
Mailing Address - Country:US
Mailing Address - Phone:972-233-6800
Mailing Address - Fax:
Practice Address - Street 1:2301 CEDAR SPRINGS RD STE 310
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7873
Practice Address - Country:US
Practice Address - Phone:972-233-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16666101Y00000X, 101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028625401Medicaid
TX1588897714Medicaid