Provider Demographics
NPI:1750770186
Name:DYCK, LISA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DYCK
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31356 VIA COLINAS STE 114
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6864
Mailing Address - Country:US
Mailing Address - Phone:805-222-6882
Mailing Address - Fax:
Practice Address - Street 1:31324 VIA COLINAS STE 108
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6756
Practice Address - Country:US
Practice Address - Phone:805-210-1869
Practice Address - Fax:818-889-1815
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist