Provider Demographics
NPI:1558579011
Name:PUISHIS, LISA (LICSW, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:PUISHIS
Suffix:
Gender:F
Credentials:LICSW, LMHC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WOLFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3041 68TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7440 W MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4141
Practice Address - Country:US
Practice Address - Phone:206-768-1990
Practice Address - Fax:206-768-8910
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008911101YM0800X
WALW00008054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker