| Lisa Heller, Lcsw, Llc | |
|
10315 Dawsons Creek Blvd Ste E Fort Wayne IN 46825-1912 | |
| (260) 437-9022 | |
| Not Available |
| Full Name | Lisa Heller, Lcsw, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10315 Dawsons Creek Blvd Ste E, Fort Wayne, Indiana |
| Authorized Official Name and Position | Lisa Heller (PRESIDENT) |
| Authorized Official Contact | 2604379022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Heller, Lcsw, Llc 10315 Dawsons Creek Blvd Ste E Fort Wayne IN 46825-1912 Ph: (260) 437-9022 | Lisa Heller, Lcsw, Llc 10315 Dawsons Creek Blvd Ste E Fort Wayne IN 46825-1912 Ph: (260) 437-9022 |
| NPI Number | 1972956522 |
|---|---|
| Provider Enumeration Date | 07/19/2016 |
| Last Update Date | 07/19/2016 |
| Medicare PECOS PAC ID | 9931493749 |
|---|---|
| Medicare Enrollment ID | O20160802001403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972956522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 34002636A (Indiana) | Primary |
| Provider Name | Lisa M Heller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992723977 PECOS PAC ID: 8426008863 Enrollment ID: I20050125000001 |
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