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NPI Code Detail

MEDICARE: MRS. LISA SMITH LICDC, SAP, LPC

MEDICARE: MRS. LISA SMITH LICDC, SAP, 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
1101YP2500XProfessional CounselorC.2003026OH
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3405300000XPrevention ProfessionalOCPC.1222OH
4101YA0400XAddiction (Substance Use Disorder) Counselor111024OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255710570
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA SMITH LICDC, SAP, LPC
Provider Business Mailing Address
First Line : 16908 WALDEN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-1542
Country : US
Telephone Number : 216-246-2944
Fax Number :
Provider Business Practice Location Address
First Line : 4100 FRANKLIN BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2842
Country : US
Telephone Number : 216-623-0959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2015
Last Update Date : 11/23/2020

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