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General NPI Number Information
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NPI Number | 1346940970
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Entity Type | Individual
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Provider Name | HEIDI LIESE LIESE EDSALL LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1555 W SUNSET BLVD STE C
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City | LOS ANGELES
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State | CA
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Zip | 90026-3333
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Country | US
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Telephone | 747-215-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 952 MALTMAN AVE APT 204
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City | LOS ANGELES
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State | CA
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Zip | 90026-2757
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Country | US
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Telephone | 323-702-3549
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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 | LMFT147442
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License Number State | CA
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