Provider Demographics
NPI:1558886754
Name:OYERVIDEZ, LISETE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISETE
Middle Name:
Last Name:OYERVIDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N CHINOWTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:559-635-4780
Mailing Address - Fax:559-635-4790
Practice Address - Street 1:3713 W HOWARD AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4027
Practice Address - Country:US
Practice Address - Phone:559-635-4780
Practice Address - Fax:559-635-4790
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106931101YM0800X
CA120625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health