Provider Demographics
NPI:1154746212
Name:GOETZ, LISA M (LPCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GOETZ
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 STATE ST STE 20
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0637
Mailing Address - Country:US
Mailing Address - Phone:701-751-8060
Mailing Address - Fax:701-751-8060
Practice Address - Street 1:4007 STATE ST STE 20
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0637
Practice Address - Country:US
Practice Address - Phone:701-751-8060
Practice Address - Fax:701-751-8060
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND774-3-1-14101YP2500X
ND774-3-1-14A101YP2500X
ND774-3-1-14-355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463183Medicaid