Provider Demographics
NPI:1922773134
Name:SLEDD, LISA (LMFTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SLEDD
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 W OLIVE AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-7245
Mailing Address - Country:US
Mailing Address - Phone:512-577-9804
Mailing Address - Fax:
Practice Address - Street 1:12598 CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3530
Practice Address - Country:US
Practice Address - Phone:909-576-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA125405Medicaid