Provider Demographics
NPI:1366528986
Name:LEE, LISHA S (MA MFT)
Entity type:Individual
Prefix:MS
First Name:LISHA
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MS
Other - First Name:LISHA
Other - Middle Name:S
Other - Last Name:SAKHRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:3425 S BASCOM AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7300
Mailing Address - Country:US
Mailing Address - Phone:201-674-7309
Mailing Address - Fax:
Practice Address - Street 1:3425 S BASCOM AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7300
Practice Address - Country:US
Practice Address - Phone:201-674-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003452101YM0800X
NJ37PC00311600101YP2500X
CA48613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003452OtherLMHC
68517OtherNCC
NJ37PC00311600OtherLPC
CA48613OtherLMFT