Provider Demographics
NPI:1851544928
Name:SOUSA-CORREIA, MAXINE S (LMFT)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:S
Last Name:SOUSA-CORREIA
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 1:4037 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7418
Mailing Address - Country:US
Mailing Address - Phone:209-678-5871
Mailing Address - Fax:209-620-8298
Practice Address - Street 1:2101 GEER RD STE 304
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2471
Practice Address - Country:US
Practice Address - Phone:209-678-5871
Practice Address - Fax:209-620-8298
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58580OtherBOARD OF BEHAVIORAL SCIENCES