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General NPI Number Information
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NPI Number | 1134920531
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Entity Type | Individual
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Provider Name | LISA MCNELLEY
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Gender | Female
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 384 BEL MARIN KEYS BLVD STE 148
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City | NOVATO
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State | CA
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Zip | 94949-5361
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Country | US
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Telephone | 415-517-7753
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MAIN DOCK WALDO POINT HARBOR
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City | SAUSALITO
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State | CA
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Zip | 94965
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Country | US
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Telephone | 145-517-7753
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 133925
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License Number State | CA
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