Provider Demographics
NPI:1275924193
Name:PIERCE, LISA J (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JOY
Other - Last Name:PELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25894
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98165
Mailing Address - Country:US
Mailing Address - Phone:206-317-1200
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:12360 LAKE CITY WAY NE STE 420
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5452
Practice Address - Country:US
Practice Address - Phone:206-317-1200
Practice Address - Fax:206-363-9639
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60877931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty