Provider Demographics
NPI:1639216377
Name:MORI, LISA TANI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:TANI
Last Name:MORI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N HARBOR BLVD
Mailing Address - Street 2:9TH FL
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-743-8741
Mailing Address - Fax:714-792-1022
Practice Address - Street 1:1440 N HARBOR BLVD
Practice Address - Street 2:9TH FL
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-743-8741
Practice Address - Fax:714-792-1022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical