Provider Demographics
NPI:1417334228
Name:HUERTA, RENE RICARDO SR (LMFT)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:RICARDO
Last Name:HUERTA
Suffix:SR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 W SHAW AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3303
Mailing Address - Country:US
Mailing Address - Phone:559-974-7644
Mailing Address - Fax:
Practice Address - Street 1:2416 W SHAW AVE STE 114
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3303
Practice Address - Country:US
Practice Address - Phone:559-974-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85515106H00000X
CA125322106H00000X
CA129815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist