Provider Demographics
NPI:1336285493
Name:FIX, LISA (MS,LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FIX
Suffix:
Gender:F
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 N PROSPECT RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4346
Mailing Address - Country:US
Mailing Address - Phone:309-834-1780
Mailing Address - Fax:877-428-7891
Practice Address - Street 1:5901 N PROSPECT RD STE 201A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4346
Practice Address - Country:US
Practice Address - Phone:309-834-1780
Practice Address - Fax:877-428-7891
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional