Provider Demographics
NPI:1699897827
Name:MCKELL, LISA B (AM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:MCKELL
Suffix:
Gender:F
Credentials:AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9969 MISTYMORN LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5459
Mailing Address - Country:US
Mailing Address - Phone:513-891-7901
Mailing Address - Fax:
Practice Address - Street 1:7794 5 MILE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2368
Practice Address - Country:US
Practice Address - Phone:513-231-8000
Practice Address - Fax:513-624-2062
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00022501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical