Provider Demographics
NPI:1659995470
Name:WILLIAMS, LISA (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W SIERRA MADRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2714
Mailing Address - Country:US
Mailing Address - Phone:626-355-5160
Mailing Address - Fax:626-355-5173
Practice Address - Street 1:1043 W AVENUE M4 STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1439
Practice Address - Country:US
Practice Address - Phone:661-723-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-42358103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst