Provider Demographics
NPI:1326411463
Name:VANHOUTEN, LISA (LISW - S)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VANHOUTEN
Suffix:
Gender:F
Credentials:LISW - S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 S BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-3202
Mailing Address - Country:US
Mailing Address - Phone:419-566-2891
Mailing Address - Fax:567-393-9480
Practice Address - Street 1:7807 STATE ROUTE 309 LOT 1
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9752
Practice Address - Country:US
Practice Address - Phone:419-566-2891
Practice Address - Fax:567-393-9480
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13023001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH162090Medicaid