Provider Demographics
NPI:1043856446
Name:LISHEBA, ALLYSON JUSTINE (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JUSTINE
Last Name:LISHEBA
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, COBA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:18151 JEFFERSON PARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3496
Practice Address - Country:US
Practice Address - Phone:330-967-0325
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst