Provider Demographics
NPI:1073353207
Name:HUELSKAMP, LISA M (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:HUELSKAMP
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14981 GANDY EDDY RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8117
Mailing Address - Country:US
Mailing Address - Phone:614-371-5000
Mailing Address - Fax:
Practice Address - Street 1:14981 GANDY EDDY RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8117
Practice Address - Country:US
Practice Address - Phone:614-371-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health