MEDICARE: LISA ANN SANCHEZ 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
1	101Y00000X	Counselor	2010019251	MO
2	101YP2500X	Professional Counselor	2010019251	MO

General Provider Information

NPI Number	:	1467773143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN SANCHEZ LPC

Provider Business Mailing Address
First Line	:	1908 BOGGS CREEK RD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-5580
Country	:	US
Telephone Number	:	573-634-4555
Fax Number	:	573-634-4352

Provider Business Practice Location Address
First Line	:	1908 BOGGS CREEK RD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-5580
Country	:	US
Telephone Number	:	573-634-4555
Fax Number	:	573-634-4352

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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