Provider Demographics
NPI:1477152064
Name:CANDELAS, CORY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CORY
Middle Name:
Last Name:CANDELAS
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 1:3400 CENTRAL AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2181
Mailing Address - Country:US
Mailing Address - Phone:951-275-3756
Mailing Address - Fax:
Practice Address - Street 1:3400 CENTRAL AVE STE 310
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2181
Practice Address - Country:US
Practice Address - Phone:951-275-3756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106895106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist