Healthcare Provider Details

I. General information

NPI: 1245034354
Provider Name (Legal Business Name): LISA SLEDD, LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 W OLIVE AVE UNIT C
MONROVIA CA
91016-7245
US

IV. Provider business mailing address

857 W OLIVE AVE UNIT C
MONROVIA CA
91016-7245
US

V. Phone/Fax

Practice location:
  • Phone: 512-577-9804
  • Fax:
Mailing address:
  • Phone: 512-577-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA SLEDD
Title or Position: PSYCHOTHERAPIST
Credential: LMFT
Phone: 512-577-9804