Provider Demographics
NPI:1821674656
Name:LISA H OKUTSU-LEMMONS
Entity Type:Organization
Organization Name:LISA H OKUTSU-LEMMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUTSU-LEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-575-0550
Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-2267
Mailing Address - Country:US
Mailing Address - Phone:559-575-0550
Mailing Address - Fax:
Practice Address - Street 1:3413 SMITH LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-4312
Practice Address - Country:US
Practice Address - Phone:559-575-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty