MEDICARE: LISA SEABRIDGE, LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356286157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA SEABRIDGE, LCSW

Provider Business Mailing Address
First Line	:	1705 EL CAMINO ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-3804
Country	:	US
Telephone Number	:	580-401-2054
Fax Number	:	580-401-2054

Provider Business Practice Location Address
First Line	:	1705 EL CAMINO ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-3804
Country	:	US
Telephone Number	:	580-401-2054
Fax Number	:	580-401-2054

Authorized Official
Title or Position	:	OWNER
Name	:	LISA ANN SEABRIDGE
Credential	:	LCSW
Telephone Number	:	580-401-2054

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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