Provider Demographics
NPI:1851944896
Name:YESENIA MADERA LICENSED MARRIAGE & FAMILY THERAPIST INC
Entity Type:Organization
Organization Name:YESENIA MADERA LICENSED MARRIAGE & FAMILY THERAPIST INC
Other - Org Name:YESENIA MADERA LICENSED MARRIAGE AND FAMILY THERAPIST INC
Other - Org Type:Other Name
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-430-0415
Mailing Address - Street 1:13601 WHITTIER BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1947
Mailing Address - Country:US
Mailing Address - Phone:626-430-0415
Mailing Address - Fax:
Practice Address - Street 1:13601 WHITTIER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1947
Practice Address - Country:US
Practice Address - Phone:626-430-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty