Provider Demographics
NPI:1891817128
Name:MIKESELL, LISA L (LCSW CACIII)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:L
Last Name:MIKESELL
Suffix:
Gender:F
Credentials:LCSW CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SUNSET PL A
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6575
Mailing Address - Country:US
Mailing Address - Phone:303-776-1117
Mailing Address - Fax:303-485-2323
Practice Address - Street 1:1801 SUNSET PL A
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6575
Practice Address - Country:US
Practice Address - Phone:303-776-1117
Practice Address - Fax:303-485-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992369101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health