Provider Demographics
NPI:1639790199
Name:MCNALLY, LISA MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2639
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:655 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2618
Practice Address - Country:US
Practice Address - Phone:614-722-8293
Practice Address - Fax:614-722-8299
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303925101YP2500X
OHC.2002426-TRNE101Y00000X
OR20-QMHA-R-0504101YA0400X
ORR7199101YM0800X
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
OR500789592Medicaid
OR500789592Medicaid