Provider Demographics
NPI:1982869194
Name:BERGFELD, LISA LAMOREAUX (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LAMOREAUX
Last Name:BERGFELD
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 1:19271 JASPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1173
Mailing Address - Country:US
Mailing Address - Phone:949-589-8040
Mailing Address - Fax:949-713-0285
Practice Address - Street 1:15510 ROCKFIELD BLVD
Practice Address - Street 2:SUITE C - 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2721
Practice Address - Country:US
Practice Address - Phone:949-709-8567
Practice Address - Fax:949-713-0285
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist