Provider Demographics
NPI:1861198715
Name:CONLEY, LISA MICHELLE (MS LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S POND CIR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3758
Mailing Address - Country:US
Mailing Address - Phone:203-464-0027
Mailing Address - Fax:
Practice Address - Street 1:10 S POND CIR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3758
Practice Address - Country:US
Practice Address - Phone:203-464-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9280323294101YS0200X
CT005792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool