Healthcare Provider Details

I. General information

NPI: 1043351752
Provider Name (Legal Business Name): LISA ANN MANTHE MFT, A.T.R. - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 STONY POINT RD
SANTA ROSA CA
95407-8080
US

IV. Provider business mailing address

PO BOX 249
MILL VALLEY CA
94942-0249
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-3700
  • Fax: 707-585-3883
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT40559
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: