Provider Demographics
NPI:1134353832
Name:BULLON, MAYRA ALBERTINI (LMFT)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALBERTINI
Last Name:BULLON
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 1:22456 SMILEY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350
Mailing Address - Country:US
Mailing Address - Phone:301-753-2212
Mailing Address - Fax:661-678-0711
Practice Address - Street 1:23822 VALENCIA BLVD.
Practice Address - Street 2:SUITE 203
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:310-753-2212
Practice Address - Fax:661-678-0711
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist