Provider Demographics
NPI:1487654026
Name:STELLINGA, LISA JOAN (MS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JOAN
Last Name:STELLINGA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SYCAMORE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-3711
Mailing Address - Country:US
Mailing Address - Phone:605-361-0114
Mailing Address - Fax:605-332-1723
Practice Address - Street 1:1500 S SYCAMORE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-3711
Practice Address - Country:US
Practice Address - Phone:605-361-0114
Practice Address - Fax:605-332-1723
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575540Medicaid
SD6575540Medicaid