Provider Demographics
NPI:1376037861
Name:PHARES, CASSANDRA NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:PHARES
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 1:26301 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6314
Mailing Address - Country:US
Mailing Address - Phone:661-713-9331
Mailing Address - Fax:
Practice Address - Street 1:10640 SCRIPPS RANCH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1095
Practice Address - Country:US
Practice Address - Phone:858-217-5770
Practice Address - Fax:619-924-9931
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist