Provider Demographics
NPI:1902359300
Name:NUISMER, ELIZABETH (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NUISMER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:VLIETSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:393 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9602
Mailing Address - Country:US
Mailing Address - Phone:616-422-5855
Mailing Address - Fax:
Practice Address - Street 1:1050 36TH ST SE
Practice Address - Street 2:400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5580
Practice Address - Country:US
Practice Address - Phone:616-965-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401015656OtherSTATE LICENSE