Provider Demographics
NPI:1821037326
Name:DELL KLISE, LISA (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DELL KLISE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:221 W CREST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1736
Practice Address - Country:US
Practice Address - Phone:760-489-4930
Practice Address - Fax:760-489-4933
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist