Individual
LISA MARIE COLLINGWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
8204 ELMBROOK DR, SUITE 360, DALLAS, TX 75247-4067
(214) 219-0780
(214) 219-0782
Mailing address
1337 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2712
(414) 897-5511
(414) 385-7552
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169676703
—
TX
01
—
8D4562
BCBS
TX
01
—
P00246197
RAILROAD
TX
Enumeration date
07/03/2006
Last updated
06/25/2018
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