Healthcare Provider Details

I. General information

NPI: 1013506823
Provider Name (Legal Business Name): JUAN GALAVIZ LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S FL 2
ORANGE CA
92868-3205
US

IV. Provider business mailing address

12851 FLOWER ST APT C
GARDEN GROVE CA
92840-6327
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6363
  • Fax:
Mailing address:
  • Phone: 714-908-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: