Provider Demographics
NPI:1427452374
Name:MCELLIGOTT, LISA KIRSTEN (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KIRSTEN
Last Name:MCELLIGOTT
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 1:16116 NW TELSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7712
Mailing Address - Country:US
Mailing Address - Phone:503-531-9503
Mailing Address - Fax:
Practice Address - Street 1:16116 NW TELSHIRE DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7712
Practice Address - Country:US
Practice Address - Phone:503-531-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health