Active NPI
Lisa Tani Mori, PH.D.
- Clinical Psychologist
- Fullerton, CA
National Provider Identifier
1639216377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10977
- Practice address
- 1440 N Harbor Blvd
9TH FL
Fullerton, CA 92835 - Phone
- (714) 743-8741
- Fax
- (714) 792-1022
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY10977 | CA | Primary |
Addresses
Primary practice location
1440 N Harbor Blvd
9TH FL
Fullerton, CA 92835
Mailing address
1440 N Harbor Blvd
9TH FL
Fullerton, CA 92835
Phone (714) 743-8741
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 7, 2022 through Jun 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY10977 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1639216377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 N HARBOR BLVD",
"address_2": "9TH FL",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92835",
"telephone_number": "714-743-8741",
"fax_number": "714-792-1022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 N HARBOR BLVD",
"address_2": "9TH FL",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92835",
"telephone_number": "714-743-8741",
"fax_number": "714-792-1022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORI",
"first_name": "LISA",
"middle_name": "TANI",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY10977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.