Provider Demographics
NPI:1871268904
Name:LISALYNN, LLC
Entity Type:Organization
Organization Name:LISALYNN, LLC
Other - Org Name:GREEN PASTURES MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:308-520-2988
Mailing Address - Street 1:967 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9022
Mailing Address - Country:US
Mailing Address - Phone:308-520-2988
Mailing Address - Fax:
Practice Address - Street 1:1912 BAY RD
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:308-520-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty