Healthcare Provider Details

I. General information

NPI: 1699147132
Provider Name (Legal Business Name): LISA MARKINSON M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARKINSON

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19634 VENTURA BLVD STE 212
TARZANA CA
91356
US

IV. Provider business mailing address

19634 VENTURA BLVD STE 212
TARZANA CA
91356-2984
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-9450
  • Fax:
Mailing address:
  • Phone: 310-666-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 87642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: