Healthcare Provider Details

I. General information

NPI: 1285013508
Provider Name (Legal Business Name): NATALIE FITZ-GORDON-LEWIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15641 GREATER TRL
CLERMONT FL
34711-8178
US

IV. Provider business mailing address

15641 GREATER TRL
CLERMONT FL
34711-8178
US

V. Phone/Fax

Practice location:
  • Phone: 352-250-7114
  • Fax:
Mailing address:
  • Phone: 352-250-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15704
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMH 13441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: