Provider Demographics
NPI:1306459029
Name:LISA EATON THERAPY AND COACHING, A LICENSED CLINICAL SOCIAL WORKER COR
Entity type:Organization
Organization Name:LISA EATON THERAPY AND COACHING, A LICENSED CLINICAL SOCIAL WORKER COR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-236-1990
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1763
Mailing Address - Country:US
Mailing Address - Phone:949-236-1990
Mailing Address - Fax:
Practice Address - Street 1:3014 LUPINE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8439
Practice Address - Country:US
Practice Address - Phone:815-985-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health