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NPI Code Detail

MEDICARE: MRS. LISA ANNE WILLMON MFT

MEDICARE:  MRS. LISA ANNE WILLMON  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
1106H00000XMarriage & Family Therapist28565CA

General Provider Information

NPI Number : 1851642565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA ANNE WILLMON MFT
Provider Business Mailing Address
First Line : 24712 MORNING STAR LN
Second Line :
City : DANA POINT
State : CA
Zip : 92629-1826
Country : US
Telephone Number : 949-371-6271
Fax Number : 951-684-4538
Provider Business Practice Location Address
First Line : 680 E COLORADO BLVD STE 180
Second Line :
City : PASADENA
State : CA
Zip : 91101-6144
Country : US
Telephone Number : 646-941-7645
Fax Number : 929-596-7897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2012
Last Update Date : 08/10/2024

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Directions to “ MRS. LISA ANNE WILLMON MFT” Practice Location

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