Provider Demographics
NPI:1013165828
Name:LOMELI, NEREIDA (MFT-I)
Entity Type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:LOMELI
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 1:1800 TULLY RD
Mailing Address - Street 2:STE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2946
Mailing Address - Country:US
Mailing Address - Phone:209-576-1750
Mailing Address - Fax:209-576-1768
Practice Address - Street 1:1800 TULLY RD
Practice Address - Street 2:STE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2946
Practice Address - Country:US
Practice Address - Phone:209-576-1750
Practice Address - Fax:209-576-1768
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health