Healthcare Provider Details

I. General information

NPI: 1154311363
Provider Name (Legal Business Name): LISA MICHELLE CREE LMHC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA HOLLEY

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SAW MILL RD STE 3200
LAFAYETTE IN
47905-5597
US

IV. Provider business mailing address

2223 CANYON CREEK DR
LAFAYETTE IN
47909-8049
US

V. Phone/Fax

Practice location:
  • Phone: 765-404-1109
  • Fax: 765-374-4164
Mailing address:
  • Phone: 765-404-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000116A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000556A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: