Provider Demographics
NPI:1578268934
Name:LISA L COSTON MS LMHC
Entity Type:Organization
Organization Name:LISA L COSTON MS LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:765-714-0545
Mailing Address - Street 1:130 N RACEWAY RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-9208
Mailing Address - Country:US
Mailing Address - Phone:765-714-0545
Mailing Address - Fax:765-441-3036
Practice Address - Street 1:10255 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7699
Practice Address - Country:US
Practice Address - Phone:765-714-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LISA L COSTON MS LMHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty