Healthcare Provider Details

I. General information

NPI: 1962869354
Provider Name (Legal Business Name): EFT RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MARENGO AVE STE 200
PASADENA CA
91101-1746
US

IV. Provider business mailing address

95 N MARENGO AVE STE 200
PASADENA CA
91101-1746
US

V. Phone/Fax

Practice location:
  • Phone: 323-633-6138
  • Fax: 626-316-6650
Mailing address:
  • Phone: 323-633-6138
  • Fax: 626-316-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC86294
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 19790
License Number StateCA

VIII. Authorized Official

Name: DR. LISA C BLUM
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 323-633-6138