Individual
MISS LISA BETH COURCHAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Mailing address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8428-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100032648
—
WI
01
—
8428-123
LICENSE
WI
Enumeration date
08/28/2013
Last updated
05/17/2023
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