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NPI Code Detail

MEDICARE: MS. LISA NICOLE CORRIGAN LMFT TRAINEE

MEDICARE: MS. LISA NICOLE CORRIGAN LMFT TRAINEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1053111294
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA NICOLE CORRIGAN LMFT TRAINEE
Provider Business Mailing Address
First Line : 1012 MARKHAM PL
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4902
Country : US
Telephone Number : 707-508-7288
Fax Number :
Provider Business Practice Location Address
First Line : 8695 WINDSOR RD
Second Line :
City : WINDSOR
State : CA
Zip : 95492-9511
Country : US
Telephone Number : 707-508-7288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2025
Last Update Date : 03/17/2025

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