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NPI Code Detail

MEDICARE: LISA SLEDD MFT

MEDICARE: LISA SLEDD MFT
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
1101YM0800XMental Health Counselor125405CA
2101YM0800XMental Health Counselor148797CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922773134
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA SLEDD MFT
Provider Business Mailing Address
First Line : 150 N SANTA ANITA AVE STE 800
Second Line :
City : ARCADIA
State : CA
Zip : 91006-3129
Country : US
Telephone Number : 512-577-9804
Fax Number :
Provider Business Practice Location Address
First Line : 150 N SANTA ANITA AVE STE 800
Second Line :
City : ARCADIA
State : CA
Zip : 91006-3129
Country : US
Telephone Number : 512-577-9804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2021
Last Update Date : 03/18/2025

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