MEDICARE: L D LUMPKIN LCSW LISAC

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	11050	AZ
2	1041C0700X	Clinical Social Worker	4026LCSW	AZ

General Provider Information

NPI Number	:	1922023621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	L D LUMPKIN LCSW LISAC

Provider Business Mailing Address
First Line	:	1695 MESQUITE AVE
Second Line	:	STE 216
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5688
Country	:	US
Telephone Number	:	928-453-0404
Fax Number	:	928-855-2778

Provider Business Practice Location Address
First Line	:	1695 MESQUITE AVE
Second Line	:	STE 216
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5688
Country	:	US
Telephone Number	:	928-453-0404
Fax Number	:	928-855-2778

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/25/2020

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