Provider Demographics
NPI:1407548159
Name:HERMOSILLO FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:HERMOSILLO FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:HERMOSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-719-6793
Mailing Address - Street 1:PO BOX 32252
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-0252
Mailing Address - Country:US
Mailing Address - Phone:323-382-8318
Mailing Address - Fax:
Practice Address - Street 1:15651 IMPERIAL HWY STE 207
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1653
Practice Address - Country:US
Practice Address - Phone:323-474-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty