MEDICARE: MRS. LISA M ADAIR L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 11755	FL

General Provider Information

NPI Number	:	1093159675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA M ADAIR L.M.H.C.

Provider Business Mailing Address
First Line	:	306 VENICE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3430
Country	:	US
Telephone Number	:	561-436-2807
Fax Number	:	561-734-1617

Provider Business Practice Location Address
First Line	:	301 N SEACREST BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4069
Country	:	US
Telephone Number	:	561-436-2807
Fax Number	:	561-734-1617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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