Provider Demographics
NPI:1841422904
Name:KELLER, LIZA GARCIA (DMFT)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:GARCIA
Last Name:KELLER
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1311
Mailing Address - Country:US
Mailing Address - Phone:323-234-4445
Mailing Address - Fax:323-234-4477
Practice Address - Street 1:5849 CROCKER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1311
Practice Address - Country:US
Practice Address - Phone:323-234-4445
Practice Address - Fax:323-234-4477
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA60751106H00000X
CA88127106H00000X
CA110899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist