Healthcare Provider Details

I. General information

NPI: 1659054591
Provider Name (Legal Business Name): AHIDE CAROLINA SAENZ LPCC, BCDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PATH MENTAL HEALTH ONLINE
LOS ANGELES CA
90027
US

IV. Provider business mailing address

11501 LOUISE AVE
LYNWOOD CA
90262-3921
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone: 310-339-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC4139
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC4139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: