Provider Demographics
NPI:1043482144
Name:COUSER, LISA L (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:COUSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 N WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2323
Mailing Address - Country:US
Mailing Address - Phone:773-450-6363
Mailing Address - Fax:
Practice Address - Street 1:6123 N WOLCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2323
Practice Address - Country:US
Practice Address - Phone:773-450-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617631OtherBLUE CROSS BLUE SHIELD
IL202591OtherMEDICARE
IL149012966Medicaid