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NPI Code Detail

MEDICARE: MRS. LISA FACKLER M.A. LPCC

MEDICARE: MRS. LISA FACKLER M.A. LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorE.2303717OH
2101YP2500XProfessional CounselorE.2303717OH

General Provider Information

NPI Number : 1346631488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA FACKLER M.A. LPCC
Provider Business Mailing Address
First Line : 615 ELSINORE PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1459
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 ELSINORE PL STE 500
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1455
Country : US
Telephone Number : 513-231-6630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2015
Last Update Date : 12/18/2024

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