Provider Demographics
NPI:1689171456
Name:ARIAGNO, LERAE (LMFT, APCC)
Entity Type:Individual
Prefix:
First Name:LERAE
Middle Name:
Last Name:ARIAGNO
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1432
Mailing Address - Country:US
Mailing Address - Phone:530-223-5122
Mailing Address - Fax:
Practice Address - Street 1:3275 SIOUX DR
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-2226
Practice Address - Country:US
Practice Address - Phone:530-524-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689171456OtherBEACON