Individual
MS. LISA MARIE MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHT, BS, MSL
Contact information
Practice address
3707 E SOUTHERN AVE STE 1081, MESA, AZ 85206-6208
(480) 709-4866
Mailing address
3707 E SOUTHERN AVE STE 1081, MESA, AZ 85206-6208
(480) 709-4866
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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