Provider Demographics
NPI:1356862072
Name:RAYAS-TABARES, PATRICIA (LICENSED MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RAYAS-TABARES
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:RAYAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3868 W CARSON ST STE 312
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6711
Mailing Address - Country:US
Mailing Address - Phone:310-920-0525
Mailing Address - Fax:
Practice Address - Street 1:3868 W CARSON ST STE 308
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6711
Practice Address - Country:US
Practice Address - Phone:310-920-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA92308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program