MEDICARE: MS. LISA TROWBRIDGE IVERSON LPC

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	C9559	OR
2	101YM0800X	Mental Health Counselor		WA

General Provider Information

NPI Number	:	1700186152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA TROWBRIDGE IVERSON LPC

Provider Business Mailing Address
First Line	:	385 SPINNAKER WAY
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9771
Country	:	US
Telephone Number	:	360-790-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 SPINNAKER WAY
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9771
Country	:	US
Telephone Number	:	360-790-2273
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	06/03/2025

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