Healthcare Provider Details

I. General information

NPI: 1447721501
Provider Name (Legal Business Name): AARON KOBA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30101 TOWN CENTER DR STE 109
LAGUNA NIGUEL CA
92677-2035
US

IV. Provider business mailing address

30101 TOWN CENTER DR STE 109
LAGUNA NIGUEL CA
92677-2035
US

V. Phone/Fax

Practice location:
  • Phone: 626-241-6807
  • Fax:
Mailing address:
  • Phone: 626-241-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT110731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: