MEDICARE: LISA BRITT, MS, EDS, LMHC, PA

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	251S00000X	Community/Behavioral Health Agency	MH7352	FL

General Provider Information

NPI Number	:	1366845349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA BRITT, MS, EDS, LMHC, PA

Provider Business Mailing Address
First Line	:	PO BOX 600353
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-0353
Country	:	US
Telephone Number	:	904-466-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 HAMPTON POINT DR STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3054
Country	:	US
Telephone Number	:	904-466-1106
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	LISA BRITT
Credential	:
Telephone Number	:	904-466-1106

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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