Provider Demographics
NPI:1508471251
Name:AGUILAR, LISBET (MS)
Entity Type:Individual
Prefix:
First Name:LISBET
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISBET
Other - Middle Name:
Other - Last Name:AGUILAR VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:47 PARK PL STE 200-E
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 PARK PL STE 200-E
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8276
Practice Address - Country:US
Practice Address - Phone:920-205-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI10137-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician