Healthcare Provider Details

I. General information

NPI: 1407386444
Provider Name (Legal Business Name): ERICKA J. LOGAN MORENO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
US

IV. Provider business mailing address

PO BOX 3965
ALHAMBRA CA
91803-0965
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-2676
  • Fax:
Mailing address:
  • Phone: 209-643-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: