Provider Demographics
NPI:1831450840
Name:LORD, KEISHA LYN (LMFT)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:LYN
Last Name:LORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:LYN
Other - Last Name:CASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:4560 HALLMARK PKWY UNIT 9095
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92427-6005
Mailing Address - Country:US
Mailing Address - Phone:909-487-5525
Mailing Address - Fax:909-232-9073
Practice Address - Street 1:2085 RUSTIN AVE STE 2002
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-955-7320
Practice Address - Fax:951-955-7203
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT106359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist