MEDICARE: MS. LISA JOAN STELLINGA MS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487654026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA JOAN STELLINGA MS

Provider Business Mailing Address
First Line	:	1500 S SYCAMORE AVE STE 102
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-3711
Country	:	US
Telephone Number	:	605-361-0114
Fax Number	:	605-332-1723

Provider Business Practice Location Address
First Line	:	1500 S SYCAMORE AVE STE 102
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-3711
Country	:	US
Telephone Number	:	605-361-0114
Fax Number	:	605-332-1723

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/12/2023

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