MEDICARE: LISA ANNE HARAM-ATKINSON M.ED., LPC, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2611	TX
2	101YP2500X	Professional Counselor	17009	TX

General Provider Information

NPI Number	:	1134207640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANNE HARAM-ATKINSON M.ED., LPC, LCDC

Provider Business Mailing Address
First Line	:	3604 WINIFRED DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2127
Country	:	US
Telephone Number	:	817-991-8638
Fax Number	:	817-810-9585

Provider Business Practice Location Address
First Line	:	3212 COLLINSWORTH ST
Second Line	:	SUITE 5
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6580
Country	:	US
Telephone Number	:	817-991-8636
Fax Number	:	817-810-9585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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