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Individual

MRS. LISA M REO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCPC, PMH

Contact information

Practice address
1052 RIVER WIND CIRCLE, BRADENTON, FL 34212
(443) 521-3685
Mailing address
517 DELTONA BLVD STE A, DELTONA, FL 32725-8016
(386) 259-5413
(386) 753-9265

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1622
FL
101YP2500X
Professional Counselor
Primary
LC8497
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000
MENTAL HEALTH
FL
05
1467691873
FL
Enumeration date
03/04/2019
Last updated
07/29/2024
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