Provider Demographics
NPI:1982894275
Name:SANTELLA, LISA KIM (MFT INTERN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:KIM
Last Name:SANTELLA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:SANTELLA
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:14535 SHERMAN CIR
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3087
Mailing Address - Country:US
Mailing Address - Phone:818-901-4854
Mailing Address - Fax:
Practice Address - Street 1:14535 SHERMAN CIR
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3087
Practice Address - Country:US
Practice Address - Phone:818-901-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist