Healthcare Provider Details

I. General information

NPI: 1043614639
Provider Name (Legal Business Name): CECELIA VALDIVIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 11/30/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N EUCLID ST # 500
ANAHEIM CA
92801-1900
US

IV. Provider business mailing address

1188 N EUCLID ST # 500
ANAHEIM CA
92801-1900
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax: 714-254-2974
Mailing address:
  • Phone: 714-644-6480
  • Fax: 714-254-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF76131
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: