Healthcare Provider Details

I. General information

NPI: 1407283849
Provider Name (Legal Business Name): LISA A BEBLEY LPC, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E COLLEGE AVE # C
WESTERVILLE OH
43081-1601
US

IV. Provider business mailing address

PO BOX 29303
COLUMBUS OH
43229-0303
US

V. Phone/Fax

Practice location:
  • Phone: 614-973-9582
  • Fax:
Mailing address:
  • Phone: 614-973-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0800125
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC 0800125
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE-1300055
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number111005
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1300055
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1300055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: