Provider Demographics
NPI:1710518642
Name:FARLOW, TONA RENEE (LMFT 132577)
Entity Type:Individual
Prefix:
First Name:TONA
Middle Name:RENEE
Last Name:FARLOW
Suffix:
Gender:F
Credentials:LMFT 132577
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 CENTRAL AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2448
Mailing Address - Country:US
Mailing Address - Phone:909-800-7754
Mailing Address - Fax:
Practice Address - Street 1:12815 HEACOCK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2836
Practice Address - Country:US
Practice Address - Phone:951-601-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132577106H00000X
CAAMFT113521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist