Provider Demographics
NPI:1053018218
Name:VILLAGOMEZ, LUISA ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:ELIZABETH
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7491 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4989
Mailing Address - Country:US
Mailing Address - Phone:954-746-5667
Mailing Address - Fax:
Practice Address - Street 1:7491 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4989
Practice Address - Country:US
Practice Address - Phone:954-746-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health