Provider Demographics
NPI:1114408838
Name:BETTCHER, LISA MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:BETTCHER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W BRANDON BLVD # 279
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5103
Mailing Address - Country:US
Mailing Address - Phone:352-577-9960
Mailing Address - Fax:
Practice Address - Street 1:1918 DARTFORD CT
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3021
Practice Address - Country:US
Practice Address - Phone:321-438-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
FLMT3376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist