Provider Demographics
NPI:1811550858
Name:IXCOL, NORMA ELIZABETH (LMFT111212)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:ELIZABETH
Last Name:IXCOL
Suffix:
Gender:F
Credentials:LMFT111212
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:ELIZABETH
Other - Last Name:URQUIDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2632
Mailing Address - Country:US
Mailing Address - Phone:433-788-8795
Mailing Address - Fax:949-460-5322
Practice Address - Street 1:7177 BROCKTON AVE STE 111
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2632
Practice Address - Country:US
Practice Address - Phone:433-788-8795
Practice Address - Fax:949-460-5322
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT111212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty