Provider Demographics
NPI:1386469674
Name:LEBSOCK, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LEBSOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 2ND ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3361
Mailing Address - Country:US
Mailing Address - Phone:727-490-9911
Mailing Address - Fax:
Practice Address - Street 1:146 2ND ST N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3361
Practice Address - Country:US
Practice Address - Phone:727-490-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171400000XOther Service ProvidersHealth & Wellness Coach
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist