Provider Demographics
NPI:1760654958
Name:COLE, LISA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E MCDOWELL RD
Mailing Address - Street 2:STE 132
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4588
Mailing Address - Country:US
Mailing Address - Phone:602-909-2496
Mailing Address - Fax:602-293-3147
Practice Address - Street 1:202 E MCDOWELL RD
Practice Address - Street 2:STE 132
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4588
Practice Address - Country:US
Practice Address - Phone:602-909-2496
Practice Address - Fax:602-293-3147
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health