Provider Demographics
NPI:1265850028
Name:NIETO-FOUST, VIVIANNA LOUISE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VIVIANNA
Middle Name:LOUISE
Last Name:NIETO-FOUST
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 1:2201 N GRAND AVE
Mailing Address - Street 2:10433
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-9998
Mailing Address - Country:US
Mailing Address - Phone:714-823-8330
Mailing Address - Fax:
Practice Address - Street 1:250 EL CAMINO REAL STE 213
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3656
Practice Address - Country:US
Practice Address - Phone:714-823-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist