Provider Demographics
NPI:1578174496
Name:ADAMS, JUDITH ANGELA (MSED, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANGELA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MSED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429-6816
Mailing Address - Country:US
Mailing Address - Phone:619-540-4190
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 604
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6933
Practice Address - Country:US
Practice Address - Phone:858-333-6856
Practice Address - Fax:858-999-2014
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist