Provider Demographics
NPI:1225212400
Name:BERNAL, DEBORAH J (MFT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BERNAL
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 1:4132 KATELLA AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3493
Mailing Address - Country:US
Mailing Address - Phone:562-598-5991
Mailing Address - Fax:562-598-5997
Practice Address - Street 1:4132 KATELLA AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3493
Practice Address - Country:US
Practice Address - Phone:714-814-0207
Practice Address - Fax:562-598-5997
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist