MEDICARE: LISA SISCO LPC

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	101YP2500X	Professional Counselor	P2105008	AR

General Provider Information

NPI Number	:	1750828133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SISCO LPC

Provider Business Mailing Address
First Line	:	5004 S U ST STE 200
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3600
Country	:	US
Telephone Number	:	479-888-8234
Fax Number	:

Provider Business Practice Location Address
First Line	:	5004 S U ST STE 200
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3600
Country	:	US
Telephone Number	:	479-888-8234
Fax Number	:

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

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/06/2026

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