Provider Demographics
NPI:1104972074
Name:EISTER, LORI MAGGELET (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MAGGELET
Last Name:EISTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MAGGELET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1025 SOUTHWOOD DR APT L
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5868
Mailing Address - Country:US
Mailing Address - Phone:805-234-3451
Mailing Address - Fax:
Practice Address - Street 1:784 HIGH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5039
Practice Address - Country:US
Practice Address - Phone:805-459-5761
Practice Address - Fax:805-540-6501
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT101769OtherBBS