Provider Demographics
NPI:1508340308
Name:TEMPLETON POE, MONIQUE RENEE
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:RENEE
Last Name:TEMPLETON POE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:RENEE
Other - Last Name:TEMPLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10026 VAN RUITEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2558
Mailing Address - Country:US
Mailing Address - Phone:562-208-7143
Mailing Address - Fax:
Practice Address - Street 1:11601 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5006
Practice Address - Country:US
Practice Address - Phone:323-242-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89855OtherOTHER
CA89855OtherOTHER