MEDICARE: LISA PRESTON

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	106H00000X	Marriage & Family Therapist	3361	FL

General Provider Information

NPI Number	:	1710576020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PRESTON

Provider Business Mailing Address
First Line	:	1570 CHESTNUT CT W
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2115
Country	:	US
Telephone Number	:	858-883-1158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 CHESTNUT CT W
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2115
Country	:	US
Telephone Number	:	858-883-1158
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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