Provider Demographics
NPI:1013344241
Name:VERNON, LISA MARIAN (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIAN
Last Name:VERNON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91021-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 N MADISON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1712
Practice Address - Country:US
Practice Address - Phone:626-710-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist