Provider Demographics
NPI:1336293943
Name:SISSON, LISA ANN (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:SISSON
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 1:645 HAMPSHIRE RD APT 128
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2317
Mailing Address - Country:US
Mailing Address - Phone:805-746-5161
Mailing Address - Fax:805-497-8040
Practice Address - Street 1:28310 ROADSIDE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2669
Practice Address - Country:US
Practice Address - Phone:805-746-5161
Practice Address - Fax:805-497-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist