Healthcare Provider Details

I. General information

NPI: 1427295914
Provider Name (Legal Business Name): LISA CONNOR LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 FAIRGROVE AVE
HAMILTON OH
45011-1966
US

IV. Provider business mailing address

PO BOX 645540
CINCINNATI OH
45264-5540
US

V. Phone/Fax

Practice location:
  • Phone: 513-889-5880
  • Fax:
Mailing address:
  • Phone: 513-887-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0600308-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: