Provider Demographics
NPI:1326553926
Name:HEREDIA FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:HEREDIA FAMILY THERAPY, INC
Other - Org Name:HEREDIA THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYD/LMFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:HEREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-243-8813
Mailing Address - Street 1:13200 CROSSROADS PKWY N STE 335
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3485
Mailing Address - Country:US
Mailing Address - Phone:562-821-1491
Mailing Address - Fax:562-362-3137
Practice Address - Street 1:13200 CROSSROADS PKWY N STE 335
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91746-3485
Practice Address - Country:US
Practice Address - Phone:323-243-8813
Practice Address - Fax:562-362-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795521041C0700X
CA92394106H00000X
CA96305106H00000X
CA91265106H00000X
CA96987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty