Provider Demographics
NPI:1255668596
Name:DUHAMELL, LISA A (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DUHAMELL
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 1:11461 ENCLAVE BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1587
Mailing Address - Country:US
Mailing Address - Phone:317-331-9112
Mailing Address - Fax:
Practice Address - Street 1:11461 ENCLAVE BLVD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1587
Practice Address - Country:US
Practice Address - Phone:317-331-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002172A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530Medicaid
IN100270530Medicaid