Provider Demographics
NPI:1629006564
Name:OTIS-TOEHAY PRADO, LA VONNE LAURINE (PSY D, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LA VONNE
Middle Name:LAURINE
Last Name:OTIS-TOEHAY PRADO
Suffix:
Gender:F
Credentials:PSY D, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43385 BUSINESS PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3692
Mailing Address - Country:US
Mailing Address - Phone:619-840-8668
Mailing Address - Fax:951-328-0722
Practice Address - Street 1:43385 BUSINESS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3692
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 101YM0800X
CALMFT52099106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health