Provider Demographics
NPI:1598889024
Name:DEAL, LISA (CADC III, CCS II)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEAL
Suffix:
Gender:F
Credentials:CADC III, CCS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 S 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2906
Mailing Address - Country:US
Mailing Address - Phone:414-364-5908
Mailing Address - Fax:
Practice Address - Street 1:169 E WISCONSIN AVE
Practice Address - Street 2:SUITE H
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3062
Practice Address - Country:US
Practice Address - Phone:262-567-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13743-135101Y00000X
WI11654-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)