Provider Demographics
NPI:1811044084
Name:WOLFE, LISA D (MS, LPC)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:D
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 PROSPECT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-2544
Mailing Address - Country:US
Mailing Address - Phone:816-404-5755
Mailing Address - Fax:816-231-4564
Practice Address - Street 1:1730 PROSPECT AVE STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-2544
Practice Address - Country:US
Practice Address - Phone:816-404-5755
Practice Address - Fax:816-231-4564
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494780604Medicaid