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General NPI Number Information
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NPI Number | 1942569579
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Entity Type | Individual
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Provider Name | LISA STRUDGEON LMFT, LMHC, RPT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 2029 OKEECHOBEE BLVD # 1019
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-4131
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Country | US
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Telephone | 352-871-3017
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Fax | 407-635-8961
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Provider Business Mailing Address
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Address Line | 7921 BONNY DR
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City | SAGINAW
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State | MI
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Zip | 48609-4912
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Country | US
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Telephone | 352-871-3017
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Fax | 407-635-8961
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH10810
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101007105
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2617
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License Number State | FL
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