Provider Demographics
NPI:1154728665
Name:BOZZOLI, LISA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOZZOLI
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 1:1630 E WILLOW DR APT 120
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1852
Mailing Address - Country:US
Mailing Address - Phone:913-314-5503
Mailing Address - Fax:
Practice Address - Street 1:501 DELAWARE ST STE 9
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2664
Practice Address - Country:US
Practice Address - Phone:913-489-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional