Provider Demographics
NPI:1578094645
Name:CROW-FUENTES, CHELSEA (LMFT, PMH-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:CROW-FUENTES
Suffix:
Gender:F
Credentials:LMFT, PMH-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1821 W BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7122
Mailing Address - Country:US
Mailing Address - Phone:949-484-5008
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:949-484-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSI5663101Y00000X
CA119059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor