Provider Demographics
NPI:1508389735
Name:LICE CLINICS OF AMERICA
Entity Type:Organization
Organization Name:LICE CLINICS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-807-3606
Mailing Address - Street 1:1329 E THOUSAND OAKS BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6257
Mailing Address - Country:US
Mailing Address - Phone:805-807-3606
Mailing Address - Fax:
Practice Address - Street 1:1329 E THOUSAND OAKS BLVD STE 128
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-6257
Practice Address - Country:US
Practice Address - Phone:805-807-3606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty