Provider Demographics
NPI:1538403613
Name:LIESKE, RICHARD PAUL (MA, MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:LIESKE
Suffix:
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:
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Mailing Address - Street 1:2900 HANNAH BLVD
Mailing Address - Street 2:SUITE B-107
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5384
Mailing Address - Country:US
Mailing Address - Phone:517-364-8087
Mailing Address - Fax:517-364-8088
Practice Address - Street 1:2900 HANNAH BLVD
Practice Address - Street 2:SUITE B-107
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5384
Practice Address - Country:US
Practice Address - Phone:517-364-8087
Practice Address - Fax:517-364-8088
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401006600101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health