MEDICARE: LISA FAYE WEDGEWORTH LPC-ASSOCIATE, LCDC

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	16850	TX
2	101YP2500X	Professional Counselor	94173	TX
3	101YM0800X	Mental Health Counselor	068.0136803TELE	VT

General Provider Information

NPI Number	:	1609412519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FAYE WEDGEWORTH LPC-ASSOCIATE, LCDC

Provider Business Mailing Address
First Line	:	3716 ALLISON DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-6008
Country	:	US
Telephone Number	:	940-799-1768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 ALLISON DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-6008
Country	:	US
Telephone Number	:	940-799-1768
Fax Number	:

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

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	12/09/2025

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