Provider Demographics
NPI:1659687606
Name:SAMAAN, LISA ISIS (MS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ISIS
Last Name:SAMAAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E DYER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5634
Mailing Address - Country:US
Mailing Address - Phone:949-410-0467
Mailing Address - Fax:
Practice Address - Street 1:17332 AMAGANSET WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2508
Practice Address - Country:US
Practice Address - Phone:714-845-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT87404106H00000X
CAIMF63844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist