Provider Demographics
NPI:1689098501
Name:HEREDIA, KARLA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 CROSSROADS PKWY N STE 335
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3485
Mailing Address - Country:US
Mailing Address - Phone:562-821-1491
Mailing Address - Fax:
Practice Address - Street 1:13200 CROSSROADS PKWY N STE 335
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91746-3485
Practice Address - Country:US
Practice Address - Phone:562-821-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73225106H00000X
CALMFT 92394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73225OtherCALIFORNIA BOARD OF BEHAVIORAL SERVICES
CA92394OtherLICENSED MARRIAGE AND FAMILY THERAPIST
CALMFT 92394OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES