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General NPI Number Information
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NPI Number | 1134369424
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Entity Type | Organization
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Legal Business Name | LIFE VISION CLINICAL GROUP CORPORATION
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 3943 IRVINE BLVD #261
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 714-291-4307
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Fax |
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD #261
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 714-291-4307
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLYSON LEE LEHRICH
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Credential | LCSW
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Telephone | 714-291-4307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS23116
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License Number State | CA
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