Healthcare Provider Details

I. General information

NPI: 1457691008
Provider Name (Legal Business Name): ALEJANDRA V VACHON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 12/16/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COUNTRY WOOD DR
POMONA CA
91766-4818
US

IV. Provider business mailing address

30 COUNTRY WOOD DR
POMONA CA
91766-4818
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-3400
  • Fax:
Mailing address:
  • Phone: 909-623-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF74022
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT110973
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT110973
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF74022
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT118401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: