Provider Demographics
NPI:1114052859
Name:HEBERT-EGGLESTON, LUELLEN M (MFT)
Entity Type:Individual
Prefix:
First Name:LUELLEN
Middle Name:M
Last Name:HEBERT-EGGLESTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 IRMA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1837
Mailing Address - Country:US
Mailing Address - Phone:510-387-2020
Mailing Address - Fax:510-680-5708
Practice Address - Street 1:17 GLEN EDEN AVE STE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4316
Practice Address - Country:US
Practice Address - Phone:510-387-2020
Practice Address - Fax:510-680-5708
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist