1922109347 NPI number — MRS. LISA JAMESON SCHAMPAN LMSW

Table of content: MRS. LISA JAMESON SCHAMPAN LMSW (NPI 1922109347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922109347 NPI number — MRS. LISA JAMESON SCHAMPAN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAMPAN
Provider First Name:
LISA
Provider Middle Name:
JAMESON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAQUA
Provider Other First Name:
LISA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922109347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 ALMA DR
Provider Second Line Business Mailing Address:
STE. 315
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-6937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-994-1175
Provider Business Mailing Address Fax Number:
972-509-9062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 ALMA DR
Provider Second Line Business Practice Location Address:
STE. 315
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-6937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-994-1175
Provider Business Practice Location Address Fax Number:
972-509-9062
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  16007 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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