Provider Demographics
NPI:1619123940
Name:DE GYARFAS, LISA HOLLEH (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HOLLEH
Last Name:DE GYARFAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:HOLLEH
Other - Last Name:MANSOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 N LAS CASAS AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3311
Mailing Address - Country:US
Mailing Address - Phone:310-459-7179
Mailing Address - Fax:
Practice Address - Street 1:5000 W SUNSET BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5861
Practice Address - Country:US
Practice Address - Phone:323-361-3903
Practice Address - Fax:323-913-3614
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health