Provider Demographics
NPI:1710335450
Name:LIESTER, COURTNEY JO (MS, LMHP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JO
Last Name:LIESTER
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JO
Other - Last Name:LUCART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHP
Mailing Address - Street 1:7905 L ST STE 410
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1732
Mailing Address - Country:US
Mailing Address - Phone:712-635-3389
Mailing Address - Fax:
Practice Address - Street 1:7905 L ST STE 410
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:712-635-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health