Provider Demographics
NPI:1255650735
Name:LULA, CLARISSE VALERIE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:CLARISSE
Middle Name:VALERIE
Last Name:LULA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1913
Mailing Address - Country:US
Mailing Address - Phone:415-454-6007
Mailing Address - Fax:415-454-9085
Practice Address - Street 1:1881 LAS GALLINAS AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1745
Practice Address - Country:US
Practice Address - Phone:415-454-6007
Practice Address - Fax:415-454-9085
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist