Provider Demographics
NPI:1376915793
Name:HANES, LISA (LMFT, RN, CNM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HANES
Suffix:
Gender:F
Credentials:LMFT, RN, CNM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:HANES
Other - Last Name:MCCLOSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2461 SANTA MONICA BLVD #302
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:917-817-9117
Mailing Address - Fax:
Practice Address - Street 1:1150 YALE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-795-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-25
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist