Provider Demographics
NPI:1548793938
Name:SOLEYMANI-ALIZADEH, LISA MARIE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SOLEYMANI-ALIZADEH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18405 KRISTI RD E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-8567
Mailing Address - Country:US
Mailing Address - Phone:816-200-7087
Mailing Address - Fax:
Practice Address - Street 1:18405 KRISTI RD E
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-8567
Practice Address - Country:US
Practice Address - Phone:816-200-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03500101YP2500X
MO2018030575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2523OtherLICENSE