Provider Demographics
NPI:1629177621
Name:ITURRIAGA, JUDITH (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ITURRIAGA
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15202 HANOVER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2628
Mailing Address - Country:US
Mailing Address - Phone:714-622-4282
Mailing Address - Fax:714-622-4283
Practice Address - Street 1:909 ELECTRIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6336
Practice Address - Country:US
Practice Address - Phone:562-799-3830
Practice Address - Fax:714-622-4283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist