Provider Demographics
NPI:1649538281
Name:GUSSIN, LISA BETH (LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:GUSSIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2562 COMMERCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289
Mailing Address - Country:US
Mailing Address - Phone:941-564-8734
Mailing Address - Fax:941-876-3452
Practice Address - Street 1:2562 COMMERCE PARKWAY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289
Practice Address - Country:US
Practice Address - Phone:941-564-8734
Practice Address - Fax:941-876-3452
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9367101YM0800X
FLMH12167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health