Provider Demographics
NPI:1376755017
Name:FASNACHT HILL, LISA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:FASNACHT HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:201 CALLE POTRANCA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:714-345-5651
Mailing Address - Fax:949-366-6350
Practice Address - Street 1:13 ORCHARD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:714-345-5651
Practice Address - Fax:949-366-6350
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical