Healthcare Provider Details

I. General information

NPI: 1346589298
Provider Name (Legal Business Name): LISETTE MEHTA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISETTE SANCHEZ PHD

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 S SEPULVEDA BLVD 11TH FLOOR
LOS ANGELES CA
90034
US

IV. Provider business mailing address

112 HARVARD AVE # 385
CLAREMONT CA
91711-4716
US

V. Phone/Fax

Practice location:
  • Phone: 909-575-8552
  • Fax:
Mailing address:
  • Phone: 818-915-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number315410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: