Provider Demographics
NPI:1366276776
Name:VALADEZ, LISA (LSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VALADEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13214 ISLE OF MAN WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7244
Mailing Address - Country:US
Mailing Address - Phone:317-345-5472
Mailing Address - Fax:
Practice Address - Street 1:13214 ISLE OF MAN WAY
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7244
Practice Address - Country:US
Practice Address - Phone:317-345-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012022A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health