Provider Demographics
NPI:1104420827
Name:FRENCH, LISA JORDAN
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JORDAN
Last Name:FRENCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:THAYER
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1956 LOTMAN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2022
Mailing Address - Country:US
Mailing Address - Phone:831-419-1106
Mailing Address - Fax:
Practice Address - Street 1:1956 LOTMAN DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2022
Practice Address - Country:US
Practice Address - Phone:831-419-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3655103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool