MEDICARE: MRS. LISA KATHLEEN WOLFF LMFT

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	RCOOO38558	WA
2	106H00000X	Marriage & Family Therapist	IMF91343	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LISAWOLFF	OTHER	WA	COUNSELOR

General Provider Information

NPI Number	:	1548372709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA KATHLEEN WOLFF LMFT

Provider Business Mailing Address
First Line	:	5320 FENTON WAY
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746
Country	:	US
Telephone Number	:	858-284-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 AUBURN BLVD.
Second Line	:	SUITE 1200
City	:	SACRAMENTO
State	:	CA
Zip	:	95841
Country	:	US
Telephone Number	:	916-922-9868
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/10/2016

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