Provider Demographics
NPI:1407283849
Name:BEBLEY, LISA A (LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BEBLEY
Suffix:
Gender:F
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29303
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-0303
Mailing Address - Country:US
Mailing Address - Phone:614-973-9582
Mailing Address - Fax:
Practice Address - Street 1:30 E COLLEGE AVE # C
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1601
Practice Address - Country:US
Practice Address - Phone:614-973-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800125101YP2500X
OHC 0800125101Y00000X
OHE-1300055101Y00000X
OH111005101YA0400X
OHE1300055101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1134527997Medicaid
OH0336521Medicaid