Healthcare Provider Details

I. General information

NPI: 1558996835
Provider Name (Legal Business Name): LISA HOLDEN LMFT131412
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 41ST AVE STE 240
CAPITOLA CA
95010-2900
US

IV. Provider business mailing address

PO BOX 1436
SOQUEL CA
95073-1436
US

V. Phone/Fax

Practice location:
  • Phone: 831-222-0073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: