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1134290208
LISA ELLEN PROVOST
EVANSVILLE, IN
NPI
1134290208
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: IN 39000109A)
Enumeration Date
2006-11-12
Last Update Date
2007-07-08
Business Address
Mrs. LISA ELLEN PROVOST MS
6221 PHYSICIANS CT
EVANSVILLE, IN 47715-4031
Phone number: 812-491-7739
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Mailing Address
Mrs. LISA ELLEN PROVOST MS
6221 PHYSICIANS CT
EVANSVILLE, IN 47715-4031
Phone number: 812-491-7739
Copy
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