Provider Demographics
NPI:1558540948
Name:EMDE, LISA MARIN (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIN
Last Name:EMDE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7823
Mailing Address - Country:US
Mailing Address - Phone:530-391-9110
Mailing Address - Fax:916-734-4150
Practice Address - Street 1:3423 KESWICK DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7823
Practice Address - Country:US
Practice Address - Phone:530-391-9110
Practice Address - Fax:916-734-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health