Provider Demographics
NPI:1760774988
Name:LERLO, ESTELLA (IMFT)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:
Last Name:LERLO
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4628
Mailing Address - Country:US
Mailing Address - Phone:562-981-9392
Mailing Address - Fax:
Practice Address - Street 1:850 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4628
Practice Address - Country:US
Practice Address - Phone:562-981-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist