MEDICARE: MRS. LISA P RITTER LMFT

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	MFC 52355	CA

General Provider Information

NPI Number	:	1538331459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA P RITTER LMFT

Provider Business Mailing Address
First Line	:	45470 CLUBHOUSE DR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-5963
Country	:	US
Telephone Number	:	858-449-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	28991 OLD TOWN FRONT ST STE 102
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-2858
Country	:	US
Telephone Number	:	951-435-0449
Fax Number	:

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	12/05/2018

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