Provider Demographics
NPI:1124286026
Name:MCGINNIS, LISA KESTANA (LMFT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:KESTANA
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:KESTANA
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-4639
Mailing Address - Fax:909-421-4600
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-4639
Practice Address - Fax:909-421-4600
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT19033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist