Provider Demographics
NPI:1952632028
Name:LAL, SHARLEEN
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:
Last Name:LAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27525 PUERTA REAL
Mailing Address - Street 2:SUITE 300 #126
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-1323
Mailing Address - Country:US
Mailing Address - Phone:310-489-7137
Mailing Address - Fax:
Practice Address - Street 1:15615 ALTON PKWY STE 250
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7308
Practice Address - Country:US
Practice Address - Phone:310-489-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist