Provider Demographics
NPI:1992242291
Name:TOOLE, LISA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TOOLE
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 RIPPLING WATER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-2902
Mailing Address - Country:US
Mailing Address - Phone:410-718-6133
Mailing Address - Fax:
Practice Address - Street 1:6506 RIPPLING WATER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-2902
Practice Address - Country:US
Practice Address - Phone:410-718-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014025048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst