Healthcare Provider Details

I. General information

NPI: 1770252413
Provider Name (Legal Business Name): LORRAINE VUELTA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

IV. Provider business mailing address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

V. Phone/Fax

Practice location:
  • Phone: 786-546-6423
  • Fax:
Mailing address:
  • Phone: 786-546-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMT-1646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: