Provider Demographics
NPI:1689710436
Name:ACEVEDO, JUAN DAVID (MFT)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DAVID
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1830
Mailing Address - Country:US
Mailing Address - Phone:949-322-4546
Mailing Address - Fax:
Practice Address - Street 1:85 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1830
Practice Address - Country:US
Practice Address - Phone:949-322-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist