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General NPI Number Information
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NPI Number | 1851642565
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Entity Type | Individual
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Provider Name | LISA ANNE WILLMON MFT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 08/10/2024
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Provider Practice Location Address
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Address Line | 680 E COLORADO BLVD STE 180
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City | PASADENA
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State | CA
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Zip | 91101-6144
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 24712 MORNING STAR LN
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City | DANA POINT
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State | CA
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Zip | 92629-1826
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Country | US
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Telephone | 949-371-6271
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Fax | 951-684-4538
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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 | 28565
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License Number State | CA
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