Provider Demographics
NPI:1154040061
Name:RINCON, LISA MICHELLE (CMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:RINCON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:PETOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1543 W 110 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3555
Mailing Address - Country:US
Mailing Address - Phone:801-592-9525
Mailing Address - Fax:
Practice Address - Street 1:2578 W 600 N STE 102
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1260
Practice Address - Country:US
Practice Address - Phone:385-220-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health