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General NPI Number Information
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NPI Number | 1073163416
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Entity Type | Individual
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Provider Name | MERNA EISSA LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 250 W MAIN ST STE 101
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City | TUSTIN
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State | CA
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Zip | 92780-7717
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Country | US
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Telephone | 949-667-3125
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6151
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-6151
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 115226
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License Number State | CA
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