Provider Demographics
NPI:1265569479
Name:KOSTANSEK, LISA ANN (PCC-S, LCDC III)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:KOSTANSEK
Suffix:
Gender:F
Credentials:PCC-S, LCDC III
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:CIHULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10454 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8748
Mailing Address - Country:US
Mailing Address - Phone:440-256-3246
Mailing Address - Fax:
Practice Address - Street 1:8445 MUNSON RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2410
Practice Address - Country:US
Practice Address - Phone:440-255-1700
Practice Address - Fax:440-205-2417
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH050505101YA0400X
OHE0003136101YM0800X
OHE003136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health