Provider Demographics
NPI:1285709048
Name:HAMMON, LISA (MFT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:HAMMON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 LEXINGTON CROSSING
Mailing Address - Street 2:357
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842
Mailing Address - Country:US
Mailing Address - Phone:916-334-6189
Mailing Address - Fax:916-784-8177
Practice Address - Street 1:1110 MELODY LANE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-782-7944
Practice Address - Fax:916-784-8177
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist