Provider Demographics
NPI:1730728783
Name:WENNINGER, LISA (LPCC, NCC, BC-TMH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WENNINGER
Suffix:
Gender:F
Credentials:LPCC, NCC, BC-TMH
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:WENNINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3045
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-3045
Mailing Address - Country:US
Mailing Address - Phone:628-261-5700
Mailing Address - Fax:
Practice Address - Street 1:1632 BROADWAY # 407
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0136
Practice Address - Country:US
Practice Address - Phone:628-261-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14315101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional