Provider Demographics
NPI:1891286704
Name:BLISSETT, LEISA Y (LCSW)
Entity Type:Individual
Prefix:
First Name:LEISA
Middle Name:Y
Last Name:BLISSETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SAINT FRANCIS DR
Mailing Address - Street 2:MEDICAL AFFAIRS
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5049
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:1012 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5097
Practice Address - Country:US
Practice Address - Phone:573-471-0330
Practice Address - Fax:573-471-0461
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180024221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical