Provider Demographics
NPI:1407905623
Name:BOBER, LISA ANN (MFC 24405)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:BOBER
Suffix:
Gender:F
Credentials:MFC 24405
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFC 24405
Mailing Address - Street 1:2951 FULTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-486-7555
Mailing Address - Fax:916-486-7557
Practice Address - Street 1:2951 FULTON AVENUE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-486-7555
Practice Address - Fax:916-486-7557
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist