Healthcare Provider Details

I. General information

NPI: 1114175486
Provider Name (Legal Business Name): LISA SCHAFER MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 N PALM AVE STE 107
FRESNO CA
93711-5763
US

IV. Provider business mailing address

7475 N PALM AVE STE 107
FRESNO CA
93711-5763
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax: 559-439-5411
Mailing address:
  • Phone: 559-439-5437
  • Fax: 559-439-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number55996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: