Provider Demographics
NPI:1871841767
Name:KOBLE, LISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KOBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54447 MT HWY 212
Mailing Address - Street 2:
Mailing Address - City:CHARLO
Mailing Address - State:MT
Mailing Address - Zip Code:59824
Mailing Address - Country:US
Mailing Address - Phone:406-644-2388
Mailing Address - Fax:
Practice Address - Street 1:51549 PIEDALUE RD
Practice Address - Street 2:
Practice Address - City:CHARLO
Practice Address - State:MT
Practice Address - Zip Code:59824-9393
Practice Address - Country:US
Practice Address - Phone:406-644-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical