Provider Demographics
NPI:1104473289
Name:ZUPAN, LISA ANN (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ZUPAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 PENNYROYAL PL
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8560
Mailing Address - Country:US
Mailing Address - Phone:419-651-1222
Mailing Address - Fax:
Practice Address - Street 1:7840 GRAPHICS WAY
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8002
Practice Address - Country:US
Practice Address - Phone:419-651-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health