Provider Demographics
NPI:1114575941
Name:GORISHEK, LINDI (LISAC)
Entity Type:Individual
Prefix:
First Name:LINDI
Middle Name:
Last Name:GORISHEK
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2514
Mailing Address - Country:US
Mailing Address - Phone:520-876-1822
Mailing Address - Fax:520-421-2708
Practice Address - Street 1:450 W ADAMSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8582
Practice Address - Country:US
Practice Address - Phone:520-635-6300
Practice Address - Fax:520-868-8159
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11781101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)