Provider Demographics
NPI:1053439836
Name:KILCREASE, LISA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KILCREASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 DREAMS END
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9662
Mailing Address - Country:US
Mailing Address - Phone:870-367-1182
Mailing Address - Fax:
Practice Address - Street 1:1371 HIGHWAY 278 W
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9663
Practice Address - Country:US
Practice Address - Phone:870-367-2141
Practice Address - Fax:870-367-2103
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2392-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical