MEDICARE: LISA RIDDLE 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	101YM0800X	Mental Health Counselor	C.2103887	OH

General Provider Information

NPI Number	:	1790555142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RIDDLE LPC

Provider Business Mailing Address
First Line	:	670 MERIDIAN WAY STE 274
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-2306
Country	:	US
Telephone Number	:	614-859-2419
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 MERIDIAN WAY STE 274
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-2306
Country	:	US
Telephone Number	:	614-859-2419
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “ LISA RIDDLE LPC” Practice Location

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