Provider Demographics
NPI:1871748988
Name:WOLF, LISA MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 BEAR CLAW WAY
Mailing Address - Street 2:APT. 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2774
Mailing Address - Country:US
Mailing Address - Phone:608-658-5256
Mailing Address - Fax:608-270-0467
Practice Address - Street 1:6333 ODANA ROAD
Practice Address - Street 2:ORION FAMILY SERVICES
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1170
Practice Address - Country:US
Practice Address - Phone:608-270-2511
Practice Address - Fax:608-270-0467
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI792-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist