Provider Demographics
NPI:1043374572
Name:STINSON, LISA DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANE
Last Name:STINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 2ND ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5474
Mailing Address - Country:US
Mailing Address - Phone:308-660-9602
Mailing Address - Fax:855-710-7722
Practice Address - Street 1:109 E 2ND ST
Practice Address - Street 2:SUITE 11
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5474
Practice Address - Country:US
Practice Address - Phone:308-660-9602
Practice Address - Fax:855-710-7722
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE858103TC0700X
CO3272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical