Individual
MRS. LISA ELLEN PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
6221 PHYSICIANS CT, EVANSVILLE, IN 47715-4031
(812) 491-7739
(812) 491-3242
Mailing address
6221 PHYSICIANS CT, EVANSVILLE, IN 47715-4031
(812) 491-7739
(812) 491-3242
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000109A
IN
Other
Enumeration date
11/12/2006
Last updated
07/08/2007
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