Provider Demographics
NPI:1578206686
Name:VILLASENOR COUNSELING: INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, A PROF
Entity Type:Organization
Organization Name:VILLASENOR COUNSELING: INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, A PROF
Other - Org Name:VILLASENOR COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-342-9986
Mailing Address - Street 1:1050 LAKES DR STE 225
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 LAKES DR STE 225
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2910
Practice Address - Country:US
Practice Address - Phone:323-977-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty