Provider Demographics
NPI:1992281786
Name:COULTER, LISA P I (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:P
Last Name:COULTER
Suffix:I
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4097 BRIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-3505
Mailing Address - Country:US
Mailing Address - Phone:484-515-7615
Mailing Address - Fax:
Practice Address - Street 1:1011 BROOKSIDE RD STE 122
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9020
Practice Address - Country:US
Practice Address - Phone:610-569-0252
Practice Address - Fax:484-460-2470
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007939L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036060860001Medicaid