Provider Demographics
NPI:1952926552
Name:LISA PORTER, FAMILY COUNSELOR, INC
Entity Type:Organization
Organization Name:LISA PORTER, FAMILY COUNSELOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-838-3888
Mailing Address - Street 1:3940 LAUREL CANYON BLVD. #484
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:619-838-3888
Mailing Address - Fax:
Practice Address - Street 1:4721 LAUREL CANYON BLVD. STE #200
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:619-838-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty