Provider Demographics
NPI:1679820518
Name:SLATER, LISA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SLATER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:140 MAYHEW WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4398
Mailing Address - Country:US
Mailing Address - Phone:925-207-5853
Mailing Address - Fax:461-253-4666
Practice Address - Street 1:140 MAYHEW WAY STE 300
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4398
Practice Address - Country:US
Practice Address - Phone:925-207-5853
Practice Address - Fax:253-461-6444
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist