Healthcare Provider Details

I. General information

NPI: 1477124832
Provider Name (Legal Business Name): LISA R. RUBENSTEIN LMHC, LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 JENKS AVE
PANAMA CITY FL
32401-2530
US

IV. Provider business mailing address

730 JENKS AVE
PANAMA CITY FL
32401-2530
US

V. Phone/Fax

Practice location:
  • Phone: 850-217-2226
  • Fax:
Mailing address:
  • Phone: 850-217-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: