Healthcare Provider Details

I. General information

NPI: 1861859480
Provider Name (Legal Business Name): MICHAEL LERNER LMFT#: 120263
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14841 YORBA ST STE 203
TUSTIN CA
92780-2942
US

IV. Provider business mailing address

14841 YORBA ST STE 203
TUSTIN CA
92780-2942
US

V. Phone/Fax

Practice location:
  • Phone: 949-546-7110
  • Fax:
Mailing address:
  • Phone: 949-546-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: