Provider Demographics
NPI:1629356936
Name:LOAR, LISA MARIE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LOAR
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MOUNT OLIVE ROAD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-405-7286
Mailing Address - Fax:
Practice Address - Street 1:7900 JOHNSON DRIVE
Practice Address - Street 2:BOX 98
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37998
Practice Address - Country:US
Practice Address - Phone:865-251-2836
Practice Address - Fax:865-251-2435
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health