Provider Demographics
NPI:1760719876
Name:WARREN, LISA M (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 EAST CALAVERAS ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001
Mailing Address - Country:US
Mailing Address - Phone:323-252-0546
Mailing Address - Fax:
Practice Address - Street 1:36 S KINNELOA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3853
Practice Address - Country:US
Practice Address - Phone:626-844-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC53629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist