Provider Demographics
NPI:1508382102
Name:LIESKE, DONALD JOSEPH (PLMHP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:LIESKE
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4393
Mailing Address - Country:US
Mailing Address - Phone:308-532-0083
Mailing Address - Fax:
Practice Address - Street 1:1300 E 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4393
Practice Address - Country:US
Practice Address - Phone:308-532-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health