Provider Demographics
NPI:1568853232
Name:LISA DYCK, LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Entity Type:Organization
Organization Name:LISA DYCK, LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Other - Org Name:LISA DYCK LMFT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DYCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:805-660-0932
Mailing Address - Street 1:31324 VIA COLINAS STE 108
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6756
Mailing Address - Country:US
Mailing Address - Phone:805-660-0932
Mailing Address - Fax:818-889-1815
Practice Address - Street 1:31324 VIA COLINAS STE 108
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6756
Practice Address - Country:US
Practice Address - Phone:805-660-0932
Practice Address - Fax:818-889-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11051966OtherDOB