Provider Demographics
NPI:1659732188
Name:CORNEJO, LUIS ALFREDO (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALFREDO
Last Name:CORNEJO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 GOLDEN GATE AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3885
Mailing Address - Country:US
Mailing Address - Phone:310-989-0330
Mailing Address - Fax:
Practice Address - Street 1:430 GOLDEN GATE AVE APT 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3885
Practice Address - Country:US
Practice Address - Phone:310-989-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist