| NPI | 1760054407 |
|---|---|
| Former Name | LISA LYNN CULLEY |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-I-003375) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADC-II.24-11-20509) |
| 175T00000X Peer Specialist (Licence: OR THW-108721) | |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2024-12-18 |