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General NPI Number Information
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NPI Number | 1306459029
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Entity Type | Organization
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Legal Business Name | LISA EATON THERAPY AND COACHING, A LICENSED CLINICAL SOCIAL WORKER COR
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 3014 LUPINE
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City | LAKE FOREST
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State | CA
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Zip | 92630-8439
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Country | US
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Telephone | 815-985-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 26741 PORTOLA PKWY STE 1E
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City | FOOTHILL RANCH
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State | CA
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Zip | 92610-1763
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Country | US
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Telephone | 949-236-1990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LISA MARIE EATON
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Credential | LCSW
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Telephone | 949-236-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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