Provider Demographics
NPI:1518456102
Name:YORK, LISA KAY (RBT 17-27938)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:YORK
Suffix:
Gender:F
Credentials:RBT 17-27938
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 E 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7614
Mailing Address - Country:US
Mailing Address - Phone:219-669-8365
Mailing Address - Fax:
Practice Address - Street 1:8207 IL-83
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464
Practice Address - Country:US
Practice Address - Phone:219-669-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-27938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician