| Doctor Name: | DR. LISA MICHELLE KOHUT |
| NPI Number: | 1245648708 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.D, ED.S, M.ED, |
| License Number: | 180.005444 |
| Business Practice Address: | 800 E Northwest Hwy Ste 104a Mount Prospect, IL - 600563457 |
| Business Phone Number: | 8478452092 |
| Business Fax Number: | |
| Mailing Address: | 571 Jennifer Cir, MUNDELEIN |
| State: | IL |
| Postal Code: | 600604111 |
| Phone Number: | 8478452092 |
| Fax Number: | |
| NPI Enumeration Date: | 07/29/2014 |
| NPI Last Update Date: | 07/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 180.005444 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |