Healthcare Provider Details

I. General information

NPI: 1740758572
Provider Name (Legal Business Name): LISA A HILL LISA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S TRACY BLVD
TRACY CA
95377-8105
US

IV. Provider business mailing address

754 GRIZZLY CT
TRACY CA
95304-5985
US

V. Phone/Fax

Practice location:
  • Phone: 209-640-4179
  • Fax:
Mailing address:
  • Phone: 209-597-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: