Provider Demographics
NPI:1881218212
Name:MCKIRCHY, LISA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:MCKIRCHY
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 1:957 E MAGDALENA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3013
Mailing Address - Country:US
Mailing Address - Phone:480-734-1850
Mailing Address - Fax:
Practice Address - Street 1:525 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3202
Practice Address - Country:US
Practice Address - Phone:602-747-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ131821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical