Provider Demographics
NPI:1235520891
Name:GANT, LIZA ABBY
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:ABBY
Last Name:GANT
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 1:23796 AVENIDA COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3413
Mailing Address - Country:US
Mailing Address - Phone:949-438-6383
Mailing Address - Fax:
Practice Address - Street 1:23441 S POINTE DR STE 180
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1550
Practice Address - Country:US
Practice Address - Phone:949-438-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist