MEDICARE: ELIZABETH BISSETT M.ED./ED.S., LMHC

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	101YM0800X	Mental Health Counselor	MH15051	FL

General Provider Information

NPI Number	:	1619487477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BISSETT M.ED./ED.S., LMHC

Provider Business Mailing Address
First Line	:	5454 LENA RD UNIT 106
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-9499
Country	:	US
Telephone Number	:	941-896-7609
Fax Number	:	941-201-4856

Provider Business Practice Location Address
First Line	:	5454 LENA RD UNIT 106
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-9499
Country	:	US
Telephone Number	:	941-896-7609
Fax Number	:	941-201-4856

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

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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