Provider Demographics
NPI:1639546781
Name:KIFT, LISA BROOKES (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BROOKES
Last Name:KIFT
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 1:119 WARD ST
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1326
Mailing Address - Country:US
Mailing Address - Phone:415-261-7143
Mailing Address - Fax:
Practice Address - Street 1:119 WARD ST
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1326
Practice Address - Country:US
Practice Address - Phone:415-261-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT45087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist