Provider Demographics
NPI:1851796866
Name:WHALIN, LISA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:WHALIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MIHELLE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2938 NORTH AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5797
Mailing Address - Country:US
Mailing Address - Phone:970-245-1616
Mailing Address - Fax:970-241-8722
Practice Address - Street 1:2938 NORTH AVE STE G
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81504-5797
Practice Address - Country:US
Practice Address - Phone:970-245-1616
Practice Address - Fax:971-241-8722
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional