Provider Demographics
NPI:1033126453
Name:MORIEL, JUAN ANTONIO (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:MORIEL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E COLORADO BLVD STE 628
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1918
Mailing Address - Country:US
Mailing Address - Phone:626-676-2419
Mailing Address - Fax:626-795-0141
Practice Address - Street 1:301 E COLORADO BLVD STE 628
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1918
Practice Address - Country:US
Practice Address - Phone:626-676-2419
Practice Address - Fax:626-795-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist