Provider Demographics
NPI:1003062167
Name:BARON, ISELA P (LMFT)
Entity Type:Individual
Prefix:
First Name:ISELA
Middle Name:P
Last Name:BARON
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 1:12625 FREDERICK ST
Mailing Address - Street 2:STE I5 PMB#289
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-0714
Mailing Address - Country:US
Mailing Address - Phone:951-223-5101
Mailing Address - Fax:
Practice Address - Street 1:23791 LONE PINE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2946
Practice Address - Country:US
Practice Address - Phone:951-223-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2020-08-26
Deactivation Date:2020-07-23
Deactivation Code:
Reactivation Date:2020-08-26
Provider Licenses
StateLicense IDTaxonomies
CA52903106H00000X
CALMFT52903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist