Provider Demographics
NPI:1053489666
Name:MOXLEY, LISA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPE
Mailing Address - Street 1:25 GAP RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8679
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:870-793-8959
Practice Address - Street 1:1109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556
Practice Address - Country:US
Practice Address - Phone:870-368-4397
Practice Address - Fax:870-368-7828
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0107030101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health