Provider Demographics
NPI:1487826459
Name:WENGER, LISA DIANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANNE
Last Name:WENGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 E SUNSHINE ST STE W29
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1237
Mailing Address - Country:US
Mailing Address - Phone:417-887-9550
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3426
Practice Address - Country:US
Practice Address - Phone:636-327-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008008554OtherPROFESSIONAL REGISTRATION