Provider Demographics
NPI:1689903700
Name:PISHA, LISA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PISHA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S WEBSTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4479
Mailing Address - Country:US
Mailing Address - Phone:630-815-3326
Mailing Address - Fax:
Practice Address - Street 1:120 S WEBSTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4479
Practice Address - Country:US
Practice Address - Phone:630-815-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-19
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist