Provider Demographics
NPI:1871681569
Name:ALTHEN, LISA EARNEST (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:EARNEST
Last Name:ALTHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21081 S WESTERN AVE STE 295
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1707
Mailing Address - Country:US
Mailing Address - Phone:310-704-7745
Mailing Address - Fax:310-787-9035
Practice Address - Street 1:21081 S WESTERN AVE STE 295
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1707
Practice Address - Country:US
Practice Address - Phone:310-704-7745
Practice Address - Fax:310-787-9035
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical