MARY KATHLEEN LICHTENWALTER LMHC CAP CCS NPI 1326104001

NPI Information

NPI: 1326104001
Provider Name: MARY KATHLEEN LICHTENWALTER, LMHC, CAP, CCS
Classification: Counselor - 101YM0800X
Specialization: Mental Health
Entity Type: Individual
PECOS Registration: Yes
Address: 1730 DUNLAWTON AVE
SUITE #3
PORT ORANGE, FL
ZIP 32127
Phone: (386) 957-3905

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NPI Details

Mary Kathleen Lichtenwalter, LMHC, CAP, CCS is a mental health counselor in Port Orange, FL with 19 years of experience. Mary Kathleen Lichtenwalter, LMHC, CAP, CCS NPI is 1326104001. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1730 DUNLAWTON AVE
SUITE #3
PORT ORANGE, FL
ZIP 32127-985
Phone: (386) 957-3905
Fax: (386) 402-8992

The NPI 1326104001 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 12/18/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	39001980A	INDIANA	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	LCAC 870056A	INDIANA	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CAP 5276	FLORIDA	No
4	101YM0800X	Counselor	Mental Health	MH10712	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200196900A	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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