Provider Demographics
NPI:1407836372
Name:PORISCH, LISA D (LPC-MH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:D
Last Name:PORISCH
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 W FULTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4377
Mailing Address - Country:US
Mailing Address - Phone:605-348-6500
Mailing Address - Fax:605-341-7409
Practice Address - Street 1:1818 W FULTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4377
Practice Address - Country:US
Practice Address - Phone:605-348-6500
Practice Address - Fax:605-341-7409
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health