Healthcare Provider Details

I. General information

NPI: 1760522775
Provider Name (Legal Business Name): MARICELA HURTADO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 W RIVERSIDE DR STE 205B
BURBANK CA
91505-4050
US

IV. Provider business mailing address

1531 FAIRFIELD ST
GLENDALE CA
91201-2739
US

V. Phone/Fax

Practice location:
  • Phone: 805-709-4281
  • Fax:
Mailing address:
  • Phone: 805-709-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: