Provider Demographics
NPI:1427343896
Name:LOCKE, LISA M (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LOCKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVE STE 514
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4816
Mailing Address - Country:US
Mailing Address - Phone:818-806-9170
Mailing Address - Fax:
Practice Address - Street 1:2625 W ALAMEDA AVE STE 514
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4816
Practice Address - Country:US
Practice Address - Phone:818-806-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist