MEDICARE: SUSAN LICHTFUSS LMHC

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	17851	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1336715507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LICHTFUSS LMHC

Provider Business Mailing Address
First Line	:	PO BOX 1446
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33061-1446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3773 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6657
Country	:	US
Telephone Number	:	877-321-7658
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	06/07/2021

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