MEDICARE: LISA MARIE COLYER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH11619	FL
2	101YP2500X	Professional Counselor	MH11619	FL
3	101Y00000X	Counselor	101Y00000X	FL

General Provider Information

NPI Number	:	1427375385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE COLYER

Provider Business Mailing Address
First Line	:	PO BOX 244
Second Line	:
City	:	BELL
State	:	FL
Zip	:	32619-0244
Country	:	US
Telephone Number	:	386-717-6134
Fax Number	:	352-554-4929

Provider Business Practice Location Address
First Line	:	4140 NW 27TH LN STE F
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6600
Country	:	US
Telephone Number	:	386-717-6134
Fax Number	:	352-554-4929

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

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	01/14/2024

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Directions to “ LISA MARIE COLYER ” Practice Location

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