Healthcare Provider Details

I. General information

NPI: 1750828133
Provider Name (Legal Business Name): LISA SISCO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 S U ST STE 200
FORT SMITH AR
72903-3600
US

IV. Provider business mailing address

5004 S U ST STE 200
FORT SMITH AR
72903-3600
US

V. Phone/Fax

Practice location:
  • Phone: 479-888-8234
  • Fax:
Mailing address:
  • Phone: 479-888-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2105008
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2105008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: