1124404025 NPI number — CLARA ANAHI HERRERA LMFT 116585

Table of content: CLARA ANAHI HERRERA LMFT 116585 (NPI 1124404025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124404025 NPI number — CLARA ANAHI HERRERA LMFT 116585

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
CLARA
Provider Middle Name:
ANAHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT 116585
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORENO
Provider Other First Name:
CLARA
Provider Other Middle Name:
ANAHI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124404025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 UTICA AVE APT 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-926-7067
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CITY PKWY W STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-480-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  116585 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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