Provider Demographics
NPI:1700301827
Name:HERMOSILLO, DESIREE RENAE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:RENAE
Last Name:HERMOSILLO
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:PO BOX 32252
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-0252
Mailing Address - Country:US
Mailing Address - Phone:323-719-6793
Mailing Address - Fax:
Practice Address - Street 1:444 E HUNTINGTON DR STE 311
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6210
Practice Address - Country:US
Practice Address - Phone:213-347-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101125101YM0800X, 106H00000X
CA122897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health