Provider Demographics
NPI:1225179252
Name:LUCERO, DENELLA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DENELLA
Middle Name:
Last Name:LUCERO
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 1:18811 HUNTINGTON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6004
Mailing Address - Country:US
Mailing Address - Phone:714-843-1914
Mailing Address - Fax:
Practice Address - Street 1:16168 BEACH BLVD STE 265
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3886
Practice Address - Country:US
Practice Address - Phone:714-843-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT27934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist