Provider Demographics
NPI:1750417200
Name:RUNYON, LISA PERGAMENT (LMHC4906)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:PERGAMENT
Last Name:RUNYON
Suffix:
Gender:F
Credentials:LMHC4906
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:PERGAMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC4906
Mailing Address - Street 1:MENTAL HEALTH CARE INC
Mailing Address - Street 2:5707 N 22ND STREET
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-272-2878
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:MENTAL HEALTH CARE INC
Practice Address - Street 2:5707 N 22ND STREET
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 49061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical