Healthcare Provider Details

I. General information

NPI: 1548735582
Provider Name (Legal Business Name): LISA MARIE SIMONIAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 N WINERY AVE
FRESNO CA
93703-2884
US

IV. Provider business mailing address

2170 N WINERY AVE
FRESNO CA
93703-2884
US

V. Phone/Fax

Practice location:
  • Phone: 949-394-5007
  • Fax:
Mailing address:
  • Phone: 949-394-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: