Provider Demographics
NPI:1962869354
Name:EFT RESOURCE CENTER
Entity type:Organization
Organization Name:EFT RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-633-6138
Mailing Address - Street 1:95 N MARENGO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1746
Mailing Address - Country:US
Mailing Address - Phone:323-633-6138
Mailing Address - Fax:626-316-6650
Practice Address - Street 1:95 N MARENGO AVE STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1746
Practice Address - Country:US
Practice Address - Phone:323-633-6138
Practice Address - Fax:626-316-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19790103T00000X
CAMFC86294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty