MEDICARE: MS. LISA ANN SISSON MA, MFT

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
1	106H00000X	Marriage & Family Therapist	MFC38379	CA

General Provider Information

NPI Number	:	1336293943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ANN SISSON MA, MFT

Provider Business Mailing Address
First Line	:	645 HAMPSHIRE RD APT 128
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2317
Country	:	US
Telephone Number	:	805-746-5161
Fax Number	:	805-497-8040

Provider Business Practice Location Address
First Line	:	28310 ROADSIDE DR
Second Line	:	SUITE 140
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2669
Country	:	US
Telephone Number	:	805-746-5161
Fax Number	:	805-497-8040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	03/17/2010

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