Provider Demographics
NPI:1487967451
Name:FURBUSH, MISTY LISSETT (LMFT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LISSETT
Last Name:FURBUSH
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 1:1320 BOYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-1740
Mailing Address - Country:US
Mailing Address - Phone:661-752-5580
Mailing Address - Fax:
Practice Address - Street 1:602 COMMERCE AVE STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3882
Practice Address - Country:US
Practice Address - Phone:661-752-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59256320800000X
CALMFT87990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist