Individual
LISA J. H. FITZGIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1003 BEAU TERRE DR, SUITE 203, BENTONVILLE, AR 72712-6738
(479) 271-8778
(888) 207-6093
Mailing address
PO BOX 2449, BENTONVILLE, AR 72712-2449
(479) 271-8778
(888) 207-6093
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
07-19P
AR
103TC0700X
Clinical Psychologist
32121
TX
103TC0700X
Clinical Psychologist
894
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-19P
LICENSE
AR
01
—
32121
LICENSE
TX
01
—
894
STATE LICENSE
OK
Enumeration date
02/19/2007
Last updated
12/12/2018
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