Provider Demographics
NPI:1841657442
Name:CROUSE, LISA (LMHC, CADC, PLMHP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CROUSE
Suffix:
Gender:F
Credentials:LMHC, CADC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-6832
Mailing Address - Country:US
Mailing Address - Phone:712-256-3131
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:712-256-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037661200Medicaid
NE10025225100Medicaid
IA470390618Medicaid
NE10025315800Medicaid