Provider Demographics
NPI:1992723977
Name:HELLER, LISA MACQUEEN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MACQUEEN
Last Name:HELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15218 N COUNTY LINE RD E
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46788-9601
Mailing Address - Country:US
Mailing Address - Phone:260-238-4151
Mailing Address - Fax:
Practice Address - Street 1:10315 DAWSONS CREEK BLVD STE E
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:260-387-6340
Practice Address - Fax:260-387-6984
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002636A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical