Provider Demographics
NPI:1841739604
Name:GREGORIAN-DELEON, NELLY (LMFT)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:GREGORIAN-DELEON
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:PO BOX 504195
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-4195
Mailing Address - Country:US
Mailing Address - Phone:760-522-7541
Mailing Address - Fax:
Practice Address - Street 1:2915 SUNSET HLS
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7854
Practice Address - Country:US
Practice Address - Phone:760-522-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist