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General NPI Number Information
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NPI Number | 1679055693
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Entity Type | Organization
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Legal Business Name | LISA CRILLEY MARRIAGE AND FAMILY THERAPY INC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 864 S. ROBERTSON BLVD. SUITE 210
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City | LOS ANGELES
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State | CA
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Zip | 90035
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Country | US
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Telephone | 323-868-5705
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Fax |
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Provider Business Mailing Address
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Address Line | 864 S. ROBERTSON BLVD. SUITE 210
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City | LOS ANGELES
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State | CA
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Zip | 90035
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Country | US
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Telephone | 323-868-5705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA CRILLEY
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Credential | LMFT
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Telephone | 323-868-5705
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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 | LMFT91239
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License Number State | CA
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