Provider Demographics
NPI:1558483636
Name:PABLO, CYREL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CYREL
Middle Name:
Last Name:PABLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:CYREL
Other - Middle Name:ANN
Other - Last Name:TANGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST STE G201
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7914
Mailing Address - Country:US
Mailing Address - Phone:657-216-6730
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE G201
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7914
Practice Address - Country:US
Practice Address - Phone:714-280-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53398101YM0800X
CA75506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558483636Medicaid