Healthcare Provider Details

I. General information

NPI: 1740879378
Provider Name (Legal Business Name): KATHERINE YVETTE CUELLAR-LEI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18672 FLORIDA ST STE 100
HUNTINGTON BEACH CA
92648-1925
US

IV. Provider business mailing address

1622 LUPINE
LAKE FOREST CA
92630-8428
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-6400
  • Fax:
Mailing address:
  • Phone: 949-357-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT119020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: