Provider Demographics
NPI:1205402880
Name:KATHERINE LISTER LMSW PLLC
Entity Type:Organization
Organization Name:KATHERINE LISTER LMSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-808-7262
Mailing Address - Street 1:901 W FENNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2484
Mailing Address - Country:US
Mailing Address - Phone:616-808-7262
Mailing Address - Fax:844-647-9797
Practice Address - Street 1:255 SEMINOLE RD STE 205
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3758
Practice Address - Country:US
Practice Address - Phone:616-808-7262
Practice Address - Fax:844-647-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty