Healthcare Provider Details

I. General information

NPI: 1184158982
Provider Name (Legal Business Name): KARISSA LENTZ PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 VISTA RIDGE CIR
NORCO CA
92860-1184
US

IV. Provider business mailing address

2260 VISTA RIDGE CIR
NORCO CA
92860-1184
US

V. Phone/Fax

Practice location:
  • Phone: 619-685-9769
  • Fax:
Mailing address:
  • Phone: 619-685-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number86987
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: