Provider Demographics
NPI:1407113376
Name:LIND, MONA-LISA (I MFT 69826)
Entity Type:Individual
Prefix:MS
First Name:MONA-LISA
Middle Name:
Last Name:LIND
Suffix:
Gender:F
Credentials:I MFT 69826
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NORTH PACIFIC COAST HWY., STE. 200A-204A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 NORTH PACIFIC COAST HWY., STE. 200A-204A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-316-1610
Practice Address - Fax:310-316-4209
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMFT69826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist