Provider Demographics
NPI:1952953614
Name:NIEBLA-BACA, LIZETH (LMFT)
Entity type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:NIEBLA-BACA
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 1:29219 SUNDIAL CIR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7363
Mailing Address - Country:US
Mailing Address - Phone:951-375-6968
Mailing Address - Fax:
Practice Address - Street 1:27851 BRADLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2213
Practice Address - Country:US
Practice Address - Phone:951-297-7878
Practice Address - Fax:951-297-3914
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist