MEDICARE: LISA BETH PALMER MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	123306	CA

General Provider Information

NPI Number	:	1922670058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BETH PALMER MA, LMFT

Provider Business Mailing Address
First Line	:	11635 MAYFIELD AVE APT 17
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-7413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13323 W WASHINGTON BLVD STE 207
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5164
Country	:	US
Telephone Number	:	774-777-6465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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