Healthcare Provider Details

I. General information

NPI: 1457050957
Provider Name (Legal Business Name): MARISSA LORENE VELA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA LORENE YBANEZ

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E FLORIDA AVE
HEMET CA
92543-4512
US

IV. Provider business mailing address

1105 E FLORIDA AVE
HEMET CA
92543-4512
US

V. Phone/Fax

Practice location:
  • Phone: 951-439-2939
  • Fax:
Mailing address:
  • Phone: 951-439-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC21743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT117506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: