Provider Demographics
NPI:1407867757
Name:WHITE, LISA E (MA , MFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:E
Last Name:WHITE
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 1:100 E THOUSAND OAKS BLVD
Mailing Address - Street 2:STE 258
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5713
Mailing Address - Country:US
Mailing Address - Phone:714-538-3631
Mailing Address - Fax:
Practice Address - Street 1:100 E THOUSAND OAKS BLVD
Practice Address - Street 2:STE 258
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5713
Practice Address - Country:US
Practice Address - Phone:714-538-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT24704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist