Healthcare Provider Details

I. General information

NPI: 1679694673
Provider Name (Legal Business Name): YVONNE DEGRASSE HERMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24031 EL TORO RD 250
LAGUNA HILLS CA
92653-3151
US

IV. Provider business mailing address

24031 EL TORO RD SUITE 250
LAGUNA HILLS CA
92653-3151
US

V. Phone/Fax

Practice location:
  • Phone: 949-768-6845
  • Fax: 949-768-5124
Mailing address:
  • Phone: 949-768-6845
  • Fax: 714-384-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC36638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: