Provider Demographics
NPI:1013103522
Name:SANTOS, ANA LISETTE (LMFT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LISETTE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LISETTE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0510
Mailing Address - Country:US
Mailing Address - Phone:209-550-5869
Mailing Address - Fax:209-523-0442
Practice Address - Street 1:1400 K ST STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1018
Practice Address - Country:US
Practice Address - Phone:209-550-5869
Practice Address - Fax:209-523-0442
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist