MEDICARE: LISA URANGA MHT AND ASSOCIATED

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	101YP2500X	Professional Counselor		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871741231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA URANGA MHT AND ASSOCIATED

Provider Business Mailing Address
First Line	:	105 KINGFISHER WAY
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-7560
Country	:	US
Telephone Number	:	919-449-8306
Fax Number	:	919-340-0671

Provider Business Practice Location Address
First Line	:	10520 LIGON MILL RD
Second Line	:	SUITE 108
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4575
Country	:	US
Telephone Number	:	919-340-0133
Fax Number	:	919-340-0671

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LISA A DRIVER
Credential	:	LPC
Telephone Number	:	919-449-8306

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	05/29/2013

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