Healthcare Provider Details

I. General information

NPI: 1356917447
Provider Name (Legal Business Name): LOUISA TAYLOR LYSTER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1836
US

IV. Provider business mailing address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1836
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-3500
  • Fax: 850-595-1400
Mailing address:
  • Phone: 850-469-3500
  • Fax: 850-595-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: