MEDICARE: LISA M ABU-BAKR MA, LPC

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	101YP2500X	Professional Counselor	2025028409	MO
2	101YM0800X	Mental Health Counselor	178015826	IL

General Provider Information

NPI Number	:	1134842651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M ABU-BAKR MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 844715
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-4715
Country	:	US
Telephone Number	:	417-761-5214
Fax Number	:	417-761-5065

Provider Business Practice Location Address
First Line	:	1423 N JEFFERSON AVE FL 3
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-1917
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:	417-761-5011

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	12/02/2025

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