Healthcare Provider Details

I. General information

NPI: 1780984195
Provider Name (Legal Business Name): HELEN CLARE WREN-RUSS LMFT #87027
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HELEN CLAIRE WREN-RUSS

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30500 ARRASTRE CANYON RD
ACTON CA
93510-2160
US

IV. Provider business mailing address

30500 ARRASTRE CANYON RD
ACTON CA
93510-2160
US

V. Phone/Fax

Practice location:
  • Phone: 661-223-8834
  • Fax: 661-269-2597
Mailing address:
  • Phone: 661-223-8834
  • Fax: 661-269-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT87027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: