Healthcare Provider Details

I. General information

NPI: 1013057934
Provider Name (Legal Business Name): LISA CLUNE LENNON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 WRIGHT ST
MARQUETTE MI
49855-1955
US

IV. Provider business mailing address

97 S 4TH ST STE C
ISHPEMING MI
49849-2168
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-7611
  • Fax: 906-228-8156
Mailing address:
  • Phone: 906-228-9699
  • Fax: 888-977-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007141
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: