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General NPI Number Information
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NPI Number | 1013362003
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Entity Type | Individual
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Provider Name | LISA KEARNS
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 1670 S AMPHLETT BLVD SUITE 115
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City | SAN MATEO
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State | CA
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Zip | 94402-2510
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Country | US
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Telephone | 650-349-7969
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Fax | 650-349-1103
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Provider Business Mailing Address
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Address Line | 320 BRIDGE RD
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City | HILLSBOROUGH
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State | CA
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Zip | 94010-6912
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Country | US
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Telephone | 650-349-7969
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Fax | 650-349-1103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF91866
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License Number State | CA
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