Provider Demographics
NPI:1841792108
Name:LESSING, LISA (LHMC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LESSING
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SWEETBRIER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-4518
Mailing Address - Country:US
Mailing Address - Phone:314-495-8938
Mailing Address - Fax:
Practice Address - Street 1:6202 CONSTITUTION DR STE B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1583
Practice Address - Country:US
Practice Address - Phone:314-495-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003212A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39003212AOtherLMHC