Provider Demographics
NPI:1750494977
Name:DETRANO, KLARA (LMFT)
Entity Type:Individual
Prefix:
First Name:KLARA
Middle Name:
Last Name:DETRANO
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 1:1150 W CAPITOL DR UNIT 119
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2275
Mailing Address - Country:US
Mailing Address - Phone:310-225-5219
Mailing Address - Fax:310-832-1362
Practice Address - Street 1:16704 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5204
Practice Address - Country:US
Practice Address - Phone:562-867-1737
Practice Address - Fax:562-867-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health