Provider Demographics
NPI:1588729149
Name:MEIER, LESTARI WISNU (MA NCC LPC)
Entity type:Individual
Prefix:MS
First Name:LESTARI
Middle Name:WISNU
Last Name:MEIER
Suffix:
Gender:F
Credentials:MA NCC LPC
Other - Prefix:MS
Other - First Name:LESTARI
Other - Middle Name:WISNU
Other - Last Name:PURBASARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7150 N TERRA VISTA DR
Mailing Address - Street 2:APT #502
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1350
Mailing Address - Country:US
Mailing Address - Phone:309-692-6912
Mailing Address - Fax:
Practice Address - Street 1:3020 W WILLOW KNOLLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1002
Practice Address - Country:US
Practice Address - Phone:309-681-5850
Practice Address - Fax:309-681-5658
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.04217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional