MEDICARE: VERONICA LEE LESTINA LCP, LMHC

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	00998	IA
2	103TC0700X	Clinical Psychologist	071007891	IL
3	103TF0200X	Forensic Psychologist	00998	IA
4	103TF0200X	Forensic Psychologist	071007891	IL

General Provider Information

NPI Number	:	1952558959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA LEE LESTINA LCP, LMHC

Provider Business Mailing Address
First Line	:	P.O. BOX 334
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627
Country	:	US
Telephone Number	:	319-669-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 AVENUE G
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-4557
Country	:	US
Telephone Number	:	319-669-9131
Fax Number	:

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	11/16/2022

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