Healthcare Provider Details

I. General information

NPI: 1982835047
Provider Name (Legal Business Name): SUZY MARIE HOVDA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CAPETOWN CIR
COSTA MESA CA
92627-6303
US

IV. Provider business mailing address

1801 CAPETOWN CIR
COSTA MESA CA
92627-6303
US

V. Phone/Fax

Practice location:
  • Phone: 949-375-1221
  • Fax: 949-722-0402
Mailing address:
  • Phone: 949-375-1221
  • Fax: 949-722-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC38638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: