Provider Demographics
NPI:1780868331
Name:AGUILAR, JUDY B (MFT I)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:B
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MFT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 MALLARD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8770
Mailing Address - Country:US
Mailing Address - Phone:530-621-5112
Mailing Address - Fax:530-295-2521
Practice Address - Street 1:2808 MALLARD LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-621-5112
Practice Address - Fax:530-295-2521
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 38548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health