Provider Demographics
NPI:1891197364
Name:CALISE, DAISY PRICILLA (LMFTA)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:PRICILLA
Last Name:CALISE
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTA
Mailing Address - Street 1:3068 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2819
Mailing Address - Country:US
Mailing Address - Phone:714-545-0644
Mailing Address - Fax:
Practice Address - Street 1:3068 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2819
Practice Address - Country:US
Practice Address - Phone:714-545-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT102365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist