Healthcare Provider Details

I. General information

NPI: 1205227584
Provider Name (Legal Business Name): CHRISTIAN QIN LISE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MAIN ST STE 350
IRVINE CA
92614-7224
US

IV. Provider business mailing address

14071 PEYTON DR UNIT 2763
CHINO HILLS CA
91709-7223
US

V. Phone/Fax

Practice location:
  • Phone: 626-678-3884
  • Fax:
Mailing address:
  • Phone: 626-678-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT106757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: