Provider Demographics
NPI:1699213488
Name:SALVATIERRA, NANCY E (LMFT125964)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:SALVATIERRA
Suffix:
Gender:F
Credentials:LMFT125964
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NANCY E DOMINGUEZ
Mailing Address - Street 1:14500 ROSCOE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4194
Mailing Address - Country:US
Mailing Address - Phone:800-764-8981
Mailing Address - Fax:818-935-6189
Practice Address - Street 1:14500 ROSCOE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4194
Practice Address - Country:US
Practice Address - Phone:626-671-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125964106H00000X
CA110077101YM0800X, 106H00000X
390200000X
CAAMFT110077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program