1730728783 NPI number — LISA WENNINGER LPCC, NCC, BC-TMH

Table of content: LISA WENNINGER LPCC, NCC, BC-TMH (NPI 1730728783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730728783 NPI number — LISA WENNINGER LPCC, NCC, BC-TMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENNINGER
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC, NCC, BC-TMH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENNINGER
Provider Other First Name:
EVELYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730728783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3045
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95502-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
628-261-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1632 BROADWAY # 407
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501-0136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
628-261-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  14315 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 14315 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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