Provider Demographics
NPI:1083067748
Name:LE REVE RENDEROS, AMY (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LE REVE RENDEROS
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2016
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7232
Practice Address - Country:US
Practice Address - Phone:951-356-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist