Provider Demographics
NPI:1407061468
Name:MORELAND, LISA (MS, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MS, LMFT, LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HOCHTRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1791 22ND ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8723
Mailing Address - Country:US
Mailing Address - Phone:715-719-0122
Mailing Address - Fax:
Practice Address - Street 1:1791 22ND ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8723
Practice Address - Country:US
Practice Address - Phone:715-719-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2728-125101YM0800X
WI566-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39760500Medicaid