Provider Demographics
NPI:1134351034
Name:HIXENBAUGH, LISA SUZANNE (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:SUZANNE
Last Name:HIXENBAUGH
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 W KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3707
Mailing Address - Country:US
Mailing Address - Phone:215-848-7716
Mailing Address - Fax:
Practice Address - Street 1:6122 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1603
Practice Address - Country:US
Practice Address - Phone:215-487-1330
Practice Address - Fax:215-487-1641
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004316101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor