Provider Demographics
NPI:1437762135
Name:POPPER, LISA LOUISE (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LOUISE
Last Name:POPPER
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 1:17284 NEWHOPE ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-8202
Mailing Address - Country:US
Mailing Address - Phone:714-658-0797
Mailing Address - Fax:
Practice Address - Street 1:17284 NEWHOPE ST STE 211
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-8202
Practice Address - Country:US
Practice Address - Phone:714-658-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist