Provider Demographics
NPI:1972209260
Name:ALBAUGH, LISA (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ALBAUGH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BOBWHITE WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5626
Mailing Address - Country:US
Mailing Address - Phone:309-826-3807
Mailing Address - Fax:
Practice Address - Street 1:200 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3997
Practice Address - Country:US
Practice Address - Phone:309-826-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health