Provider Demographics
NPI:1508527425
Name:HOLDEN, LISA MIA (LAMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MIA
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8964
Mailing Address - Country:US
Mailing Address - Phone:520-560-3362
Mailing Address - Fax:520-340-5098
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:520-560-3362
Practice Address - Fax:520-340-5098
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist