Provider Demographics
NPI:1366501751
Name:DE LEON, AURELIA CYNTHIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:AURELIA
Middle Name:CYNTHIA
Last Name:DE LEON
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 1:516 VILLA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0899
Mailing Address - Country:US
Mailing Address - Phone:559-288-9508
Mailing Address - Fax:
Practice Address - Street 1:516 VILLA AVE STE 3
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0899
Practice Address - Country:US
Practice Address - Phone:559-288-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT48518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist