Basic Information
| Provider Information | |||||||||
| NPI: | 1437375342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERARD | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | M.S., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14600 SHERMAN WAY | ||||||||
| Address2: | SUTITE 100 D | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183746901 | ||||||||
| FaxNumber: | 8189099980 | ||||||||
| Practice Location | |||||||||
| Address1: | 14600 SHERMAN WAY | ||||||||
| Address2: | SUITE 100D | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183746901 | ||||||||
| FaxNumber: | 8189099980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 52426 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.