Provider Demographics
NPI:1114703741
Name:SELLS, LISA ELAINE (LMHCA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:SELLS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELAINE
Other - Last Name:CHARLESWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12948 COLDWATER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8016
Mailing Address - Country:US
Mailing Address - Phone:260-373-0880
Mailing Address - Fax:260-373-0881
Practice Address - Street 1:12948 COLDWATER RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8016
Practice Address - Country:US
Practice Address - Phone:260-373-0880
Practice Address - Fax:260-373-0881
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN880017954A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health