MEDICARE: MRS. LISA ANN LEONE MS. ED.

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

General Provider Information

NPI Number	:	1124484753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANN LEONE MS. ED.

Provider Business Mailing Address
First Line	:	10046 DUNKIRK RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-4456
Country	:	US
Telephone Number	:	352-678-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	20162 CORTEZ BLVD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34601-3832
Country	:	US
Telephone Number	:	352-334-0304
Fax Number	:

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

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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