MEDICARE: LISA STRUDGEON LMFT, LMHC, RPT

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	101YP2500X	Professional Counselor	MH10810	FL
2	106H00000X	Marriage & Family Therapist	4101007105	MI
3	106H00000X	Marriage & Family Therapist	MT2617	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1942569579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA STRUDGEON LMFT, LMHC, RPT

Provider Business Mailing Address
First Line	:	7921 BONNY DR
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48609-4912
Country	:	US
Telephone Number	:	352-871-3017
Fax Number	:	407-635-8961

Provider Business Practice Location Address
First Line	:	2029 OKEECHOBEE BLVD # 1019
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4131
Country	:	US
Telephone Number	:	352-871-3017
Fax Number	:	407-635-8961

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

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/06/2021

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