Individual provider Active NPI

Lisa J Bildeaux, MA, LPCC

  • Professional Counselor
  • Okemos, MI
National Provider Identifier
1720699077
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2561 Issued in MN
Practice address
2222 W Grand River Ave Ste a
Okemos, MI 48864-1604
Phone
(651) 677-4639
Fax
(651) 677-4640
NPI assigned
Aug 11, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2561 MN
Professional Counselor 101YP2500X 2561 MN Primary

Addresses

Primary practice location

2222 W Grand River Ave Ste a
Okemos, MI 48864-1604

Mailing address

2222 W Grand River Ave Ste a
Okemos, MI 48864-1604
Phone (651) 677-4639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240109003989 MN Practitioner - Mental Health Counselor 4486005998 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeview Behavioral Health IncGroup PAC ID 9537432307, 24 clinicians

Practice addresses (Care Compare)

516 S Pokegama Ave
Grand Rapids, MN 55744-3800
Phone (218) 327-2001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
2561MNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Specialty Group PA Mental Health CurrentSince May 1, 2025 Accepting new patients
Lakeview Behavioral Health Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

516 S Pokegama Ave
Grand Rapids, MN 55744
Phone (218) 327-2001

729 Washington Ave N
Ste 600
Minneapolis, MN 55401
Phone (334) 463-3099

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1720699077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 W GRAND RIVER AVE STE A",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488641604",
            "telephone_number": "651-677-4639",
            "fax_number": "651-677-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 W GRAND RIVER AVE STE A",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488641604",
            "telephone_number": "651-677-4639",
            "fax_number": "651-677-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BILDEAUX",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "MA, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2561",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "2561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okemos, MI

Sources for this page

Verify at the official NPI Registry.