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General NPI Number Information
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NPI Number | 1063731917
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Entity Type | Individual
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Provider Name | LISA MOHAWK LPC, CSAC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | W12802 COUNTY HWY A
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City | BOWLER
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State | WI
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Zip | 54416
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Country | US
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Telephone | 715-793-3000
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Fax | 715-793-1312
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Provider Business Mailing Address
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Address Line | 8896 SANDALWOOD CT
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City | WOODRUFF
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State | WI
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Zip | 54568-9339
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Country | US
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Telephone | 715-584-0440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15441-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5758-125
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License Number State | WI
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