Provider Demographics
NPI:1346015039
Name:LUSTGARTEN, ELIZABETH (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LUSTGARTEN
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9041 EXECUTIVE PARK DR STE 275-B
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4621
Mailing Address - Country:US
Mailing Address - Phone:865-333-4931
Mailing Address - Fax:
Practice Address - Street 1:402 GREENBELT DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5702
Practice Address - Country:US
Practice Address - Phone:865-333-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional