Provider Demographics
NPI:1396153490
Name:TSUTSUMIDA, LILY FRANCES (LMFT, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:LILY
Middle Name:FRANCES
Last Name:TSUTSUMIDA
Suffix:
Gender:F
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:FRANCES
Other - Last Name:BRAVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, ATR-BC
Mailing Address - Street 1:2900 BRISTOL ST STE C208
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5946
Mailing Address - Country:US
Mailing Address - Phone:949-478-0206
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE C208
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:949-478-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16-384221700000X
CA106288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty