MEDICARE: MS. LISA LISEC NCC, PLPC

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	101Y00000X	Counselor	2014034915	MO

General Provider Information

NPI Number	:	1851745202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA LISEC NCC, PLPC

Provider Business Mailing Address
First Line	:	529 SE 2ND ST
Second Line	:	SUITE A
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2694
Country	:	US
Telephone Number	:	816-875-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 SE 2ND ST
Second Line	:	SUITE A
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2694
Country	:	US
Telephone Number	:	816-875-0235
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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