Provider Demographics
NPI:1780984195
Name:WREN-RUSS, HELEN CLARE (LMFT #87027)
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:CLARE
Last Name:WREN-RUSS
Suffix:
Gender:F
Credentials:LMFT #87027
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:CLAIRE
Other - Last Name:WREN-RUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30500 ARRASTRE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-2160
Mailing Address - Country:US
Mailing Address - Phone:661-223-8834
Mailing Address - Fax:661-269-2597
Practice Address - Street 1:30500 ARRASTRE CANYON RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-2160
Practice Address - Country:US
Practice Address - Phone:661-223-8834
Practice Address - Fax:661-269-2597
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT87027106H00000X
CA87027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
999999999OtherNONE