Provider Demographics
NPI:1225223100
Name:SEXTON, LISA K (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:SEXTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1828
Mailing Address - Country:US
Mailing Address - Phone:574-288-7633
Mailing Address - Fax:
Practice Address - Street 1:205 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1828
Practice Address - Country:US
Practice Address - Phone:574-288-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health