Provider Demographics
NPI:1477758852
Name:MOUNT, LISA JANETTE (LCSW, BACS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANETTE
Last Name:MOUNT
Suffix:
Gender:F
Credentials:LCSW, BACS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JANETTE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 WOODRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4564
Mailing Address - Country:US
Mailing Address - Phone:318-704-0640
Mailing Address - Fax:318-704-0642
Practice Address - Street 1:1403 METRO DR STE G
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3446
Practice Address - Country:US
Practice Address - Phone:318-704-0640
Practice Address - Fax:318-704-0642
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical