Lisa Tackett

NPI #1508267287 in Troy, Missouri

Provider Information

NPI Number: 1508267287
Entity Type: Individual
Name: Lisa Tackett
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Enumeration Date: Sep 12, 2014
Last Updated: Sep 22, 2014

Practice Location

Address: 607 WOOD BRIAR DR
City: Troy
State: Missouri
ZIP Code: 63379-4961
Phone: (636) 290-3401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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