Provider Demographics
NPI:1942569579
Name:STRUDGEON, LISA (LMFT, LMHC, RPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STRUDGEON
Suffix:
Gender:F
Credentials:LMFT, LMHC, RPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:LITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7921 BONNY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-4912
Mailing Address - Country:US
Mailing Address - Phone:352-871-3017
Mailing Address - Fax:407-635-8961
Practice Address - Street 1:2029 OKEECHOBEE BLVD # 1019
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4131
Practice Address - Country:US
Practice Address - Phone:352-871-3017
Practice Address - Fax:407-635-8961
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10810101YP2500X
MI4101007105106H00000X
FLMT2617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional