Provider Demographics
NPI:1407013287
Name:SILAS, LUENETTA J (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:LUENETTA
Middle Name:J
Last Name:SILAS
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1612
Mailing Address - Country:US
Mailing Address - Phone:310-352-6422
Mailing Address - Fax:310-352-6480
Practice Address - Street 1:555 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1612
Practice Address - Country:US
Practice Address - Phone:310-352-6422
Practice Address - Fax:310-352-6480
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist