Provider Demographics
NPI:1891410551
Name:BESCH, LISA LEE (MED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:BESCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9207
Mailing Address - Country:US
Mailing Address - Phone:972-339-0357
Mailing Address - Fax:
Practice Address - Street 1:971 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9207
Practice Address - Country:US
Practice Address - Phone:972-339-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8586OtherNO NUMBERS