Provider Demographics
NPI:1780404426
Name:TODD, LISA MARIE (PPS, ASC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:TODD
Suffix:
Gender:F
Credentials:PPS, ASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DISTRICT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-3626
Mailing Address - Country:US
Mailing Address - Phone:760-883-2703
Mailing Address - Fax:
Practice Address - Street 1:150 DISTRICT CENTER DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-3626
Practice Address - Country:US
Practice Address - Phone:760-883-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool