Provider Demographics
NPI:1013298678
Name:MERRY, LISA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27201 PUERTA REAL STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8590
Mailing Address - Country:US
Mailing Address - Phone:949-922-7808
Mailing Address - Fax:949-449-8232
Practice Address - Street 1:27201 PUERTA REAL STE 300
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8590
Practice Address - Country:US
Practice Address - Phone:949-922-7808
Practice Address - Fax:949-449-8232
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT50270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health