Healthcare Provider Details

I. General information

NPI: 1902925035
Provider Name (Legal Business Name): LISA BALDWIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/20/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 BARRANCA PKWY STE 101E
IRVINE CA
92604-1727
US

IV. Provider business mailing address

P.O. BOX 52374 LISA BALDWIN
IRVINE CA
92619
US

V. Phone/Fax

Practice location:
  • Phone: 194-922-4315
  • Fax: 949-236-6426
Mailing address:
  • Phone: 949-224-3155
  • Fax: 949-427-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39972
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: