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General NPI Number Information
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NPI Number | 1003678624
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Entity Type | Individual
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Provider Name | LISA LYNN BALDERSTONE
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 5331 COMMERCIAL WAY STE 209
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City | SPRING HILL
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State | FL
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Zip | 34606-1426
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Country | US
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Telephone | 352-515-0000
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Fax | 352-556-5729
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Provider Business Mailing Address
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Address Line | 3986 BRAMBLEWOOD LOOP
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City | SPRING HILL
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State | FL
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Zip | 34609-0664
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Country | US
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Telephone | 989-482-9858
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Fax | 352-556-5729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ISW17277
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License Number State | FL
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