Provider Demographics
NPI:1689851271
Name:HOLLIDAY-AGGERS, LISA (LEP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:HOLLIDAY-AGGERS
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-0272
Mailing Address - Country:US
Mailing Address - Phone:626-852-0282
Mailing Address - Fax:
Practice Address - Street 1:1433 E ROUTE 66
Practice Address - Street 2:SUITE E
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3747
Practice Address - Country:US
Practice Address - Phone:626-905-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2611103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool