Provider Demographics
NPI:1336298207
Name:LULOFS, LISA GAUGER (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAUGER
Last Name:LULOFS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1245
Mailing Address - Country:US
Mailing Address - Phone:850-402-0606
Mailing Address - Fax:850-942-8664
Practice Address - Street 1:2390 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5326
Practice Address - Country:US
Practice Address - Phone:850-402-0606
Practice Address - Fax:850-942-8664
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 79861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical