| Doctor Name: | STACIA MARIE NISSEN |
| NPI Number: | 1295970986 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, NCC, CCDCIII |
| License Number: | 225554 |
| Business Practice Address: | 1714 Abbey Rd Pierre, SD - 575017805 |
| Business Phone Number: | 6052248841 |
| Business Fax Number: | 6052246852 |
| Mailing Address: | 1714 Abbey Rd, PIERRE |
| State: | SD |
| Postal Code: | 575017805 |
| Phone Number: | 6052248841 |
| Fax Number: | 6052246852 |
| NPI Enumeration Date: | 12/09/2008 |
| NPI Last Update Date: | 05/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 225554 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |