Lisa La'Ree Kishiyama, LMSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LMSW-31426 Issued in ID

Practice address

660 S Woodruff Ave
Idaho Falls, ID 83401-5299

Phone

(208) 523-1558

Fax

(208) 529-4788

NPI assigned

Jun 16, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sullivan Mental Health Services LLC

  • Adult Mental Health Clinic/Center
  • Idaho Falls, ID
  • NPI 1003101577
  NPD (past)

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1982999074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 SAINT CHARLES AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047330",
            "telephone_number": "208-681-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015299",
            "telephone_number": "208-523-1558",
            "fax_number": "208-529-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHIYAMA",
        "first_name": "LISA",
        "middle_name": "LA'REE",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LMSW-31426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kinghorn
• Matthew Scott Kinghorn, FNP-C
• Julia Evalyne Kippen, LMSW
• Claudia Roberts Kirchgasler, MA CCC SLP
• Thomas Michael Kirschen, DO
• Kistler Dental PLLC
• Kolby Tronier Klingler, D.M.D.
• William Kenneth Klingler, DMD
• Ashley Morgan Klink, PA-C
• Steven V Klippert, MD

• Professional Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.