Lisa Mary Probst, LMFT 90976

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

90976 Issued in CA

Practice address

5150 E Pacific Coast Hwy Ste 100
Long Beach, CA 90804-3394

Phone

(562) 490-7638

Fax

(562) 490-7601

NPI assigned

Jun 21, 2012

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Allyson Wells MD Inc

  • Child & Adolescent Psychiatry Physician
  • Long Beach, CA
  • NPI 1770181257
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  NPD
• Childnet Youth and Family Services Inc

  dba ChildNet Youth & Family Services Inc.

  • Community/Behavioral Health Agency
  • Long Beach, CA
  • NPI 1760519219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164785341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "562-490-7638",
            "fax_number": "562-490-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 E PACIFIC COAST HWY STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908043394",
            "telephone_number": "562-490-7638",
            "fax_number": "562-490-7601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5300 Angeles Vista Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90043",
            "country_code": "US",
            "telephone_number": "323-295-4555",
            "fax_number": "323-295-3021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROBST",
        "first_name": "LISA",
        "middle_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "LMFT 90976",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-21",
        "last_updated": "2022-07-21",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "90976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "393 E Walnut St",
            "city": "Pasadena",
            "state": "CA",
            "country_code": "US",
            "postal_code": "911880001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Prime RX, Inc.
• Krystin Prince
• Nichole Prince
• Priority Care Home Health LLC
• Proactive Hospice Inc
• Ernest Prochazka
• Samantha Prochnow, ACSW
• James F Proetz, D.C.
• Professional Pathology Medical Group, Inc.
• Progen Autotransfusion/Coronary Support Services, Inc

• Marriage & Family Therapist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.