Provider Demographics
NPI:1629711890
Name:HAM, LISA NESBETH (AMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NESBETH
Last Name:HAM
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E HICKORY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7274
Mailing Address - Country:US
Mailing Address - Phone:804-441-5336
Mailing Address - Fax:
Practice Address - Street 1:115 E HICKORY AVE STE C
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7274
Practice Address - Country:US
Practice Address - Phone:804-441-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty