MEDICARE: LISA CONNER LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		IA

General Provider Information

NPI Number	:	1356097547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CONNER LMHC

Provider Business Mailing Address
First Line	:	1601 MILITARY RD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51103-1715
Country	:	US
Telephone Number	:	712-252-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 N 17TH ST STE 1
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4211
Country	:	US
Telephone Number	:	515-576-4156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	02/25/2022

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