Provider Demographics
NPI:1801196902
Name:RILEY, LISA A (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 E FOOTHILL BLVD # 114
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3119
Mailing Address - Country:US
Mailing Address - Phone:626-817-2278
Mailing Address - Fax:
Practice Address - Street 1:911 E COLORADO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1773
Practice Address - Country:US
Practice Address - Phone:626-817-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist