Provider Demographics
NPI:1235488255
Name:VILLEGAS REYES, MIROSLAVA (LMFT)
Entity Type:Individual
Prefix:
First Name:MIROSLAVA
Middle Name:
Last Name:VILLEGAS REYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-4023
Mailing Address - Country:US
Mailing Address - Phone:909-568-8797
Mailing Address - Fax:
Practice Address - Street 1:1908 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3436
Practice Address - Country:US
Practice Address - Phone:909-890-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2015-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist