Healthcare Provider Details

I. General information

NPI: 1992807507
Provider Name (Legal Business Name): LISA ANNE LYSNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CENTRAL AVE STE 502
GREAT FALLS MT
59401-3128
US

IV. Provider business mailing address

410 CENTRAL AVE STE 502
GREAT FALLS MT
59401-3128
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-3152
  • Fax: 406-727-3172
Mailing address:
  • Phone: 406-727-3152
  • Fax: 406-727-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number471LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: