Provider Demographics
NPI:1043427719
Name:DESMOND, LOIS M (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:M
Last Name:DESMOND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:LOIS
Other - Middle Name:M
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30649 RIGGER RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1921
Mailing Address - Country:US
Mailing Address - Phone:424-347-9299
Mailing Address - Fax:310-325-9302
Practice Address - Street 1:2075 PALOS VERDES DR N STE 218
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3726
Practice Address - Country:US
Practice Address - Phone:424-347-9299
Practice Address - Fax:310-325-9302
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT43944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB 32042OtherBOARD OF PSYCHOLOGY LIC.