Provider Demographics
NPI:1700386539
Name:LEWIS, LISA (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2883 TANOBLE DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1811
Mailing Address - Country:US
Mailing Address - Phone:626-319-5076
Mailing Address - Fax:
Practice Address - Street 1:454 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3129
Practice Address - Country:US
Practice Address - Phone:626-319-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist