Provider Demographics
NPI:1326421090
Name:SHUSTER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHUSTER
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 1:715 13TH AVE NE
Mailing Address - Street 2:APT 307
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2300
Mailing Address - Country:US
Mailing Address - Phone:701-330-9998
Mailing Address - Fax:
Practice Address - Street 1:715 13TH AVE NE
Practice Address - Street 2:APT 307
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2300
Practice Address - Country:US
Practice Address - Phone:701-330-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND38391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical