=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396113916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA SIMPSON LMHC LCAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 04/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1156 OLD STATE ROAD 46
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47448-9211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-988-2258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 ARTIST DR APT B
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47448-8104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 87000859A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 39003000A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------