Provider Demographics
NPI:1861859480
Name:LERNER, MICHAEL (LMFT#: 120263)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:LMFT#: 120263
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14841 YORBA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2942
Mailing Address - Country:US
Mailing Address - Phone:949-546-7110
Mailing Address - Fax:
Practice Address - Street 1:14841 YORBA ST STE 203
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2942
Practice Address - Country:US
Practice Address - Phone:949-546-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA120263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program