Provider Demographics
NPI:1710667159
Name:LISOWE, TABITHA NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:NICOLE
Last Name:LISOWE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:NICOLE
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 N 12TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1308
Mailing Address - Country:US
Mailing Address - Phone:414-219-5219
Mailing Address - Fax:
Practice Address - Street 1:1020 N 12TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-219-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist