Provider Demographics
NPI:1093445272
Name:CLAPP, LIISA
Entity Type:Individual
Prefix:
First Name:LIISA
Middle Name:
Last Name:CLAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 SAINT GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:ND
Mailing Address - Zip Code:58564-4103
Mailing Address - Country:US
Mailing Address - Phone:701-597-3419
Mailing Address - Fax:
Practice Address - Street 1:7785 SAINT GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:ND
Practice Address - Zip Code:58564-4103
Practice Address - Country:US
Practice Address - Phone:701-597-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2022-062A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist