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General NPI Number Information
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NPI Number | 1205402880
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Entity Type | Organization
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Legal Business Name | KATHERINE LISTER LMSW PLLC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 255 SEMINOLE RD STE 205
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City | NORTON SHORES
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State | MI
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Zip | 49444-3758
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Country | US
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Telephone | 616-808-7262
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Fax | 844-647-9797
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Provider Business Mailing Address
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Address Line | 901 W FENNWOOD CIR
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City | MUSKEGON
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State | MI
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Zip | 49445-2484
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Country | US
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Telephone | 616-808-7262
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Fax | 844-647-9797
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Authorized Official
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Title or Position | MANAGER
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Name | KATHERINE LISTER
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Credential | LMSW
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Telephone | 616-808-7262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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