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General NPI Number Information
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NPI Number | 1578268934
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Entity Type | Organization
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Legal Business Name | LISA L COSTON MS LMHC
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 10255 COMMERCE DR
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City | CARMEL
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State | IN
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Zip | 46032-7699
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Country | US
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Telephone | 765-714-0545
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Fax |
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Provider Business Mailing Address
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Address Line | 130 N RACEWAY RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-9208
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Country | US
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Telephone | 765-714-0545
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Fax | 765-441-3036
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Authorized Official
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Title or Position | OWNER
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Name | LISA LYNN COSTON
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Credential | MS LMHC
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Telephone | 765-714-0545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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