Provider Demographics
NPI:1629094057
Name:CUEVA-MILLER, LAURA M (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:CUEVA-MILLER
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:DECHENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4515 CENTRAL AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2374
Mailing Address - Country:US
Mailing Address - Phone:951-788-6006
Mailing Address - Fax:951-788-4486
Practice Address - Street 1:4515 CENTRAL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2374
Practice Address - Country:US
Practice Address - Phone:951-788-6006
Practice Address - Fax:951-788-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical