Provider Demographics
NPI:1629410287
Name:RICO, LOURDES KARINA (LMFT)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:KARINA
Last Name:RICO
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 1:2294 ELEMENT WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2801
Mailing Address - Country:US
Mailing Address - Phone:626-434-9417
Mailing Address - Fax:
Practice Address - Street 1:2294 ELEMENT WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2801
Practice Address - Country:US
Practice Address - Phone:626-434-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96143106H00000X
CA75815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist