Provider Demographics
NPI:1851745202
Name:LISEC, LISA (NCC, PLPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LISEC
Suffix:
Gender:F
Credentials:NCC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SE 2ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2694
Mailing Address - Country:US
Mailing Address - Phone:816-875-0235
Mailing Address - Fax:
Practice Address - Street 1:529 SE 2ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2694
Practice Address - Country:US
Practice Address - Phone:816-875-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014034915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor