Provider Demographics
NPI:1063731917
Name:MOHAWK, LISA (LPC, CSAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MOHAWK
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8896 SANDALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9339
Mailing Address - Country:US
Mailing Address - Phone:715-584-0440
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY HWY A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416
Practice Address - Country:US
Practice Address - Phone:715-793-3000
Practice Address - Fax:715-793-1312
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15441-132101YA0400X
WI5758-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI101YP2500XMedicaid
WI101YA0400XMedicaid