Provider Demographics
NPI:1467873323
Name:NIEMISTO, LISA DIANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:NIEMISTO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4783
Mailing Address - Country:US
Mailing Address - Phone:906-227-9119
Mailing Address - Fax:906-228-2469
Practice Address - Street 1:347 ROCK ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4783
Practice Address - Country:US
Practice Address - Phone:906-227-9119
Practice Address - Fax:906-228-2469
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC02843101YA0400X
MI6801095909101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health