Healthcare Provider Details

I. General information

NPI: 1265697940
Provider Name (Legal Business Name): LETICIA C. COUNCIL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LETICIA C. NORIEGA LCSW

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32036 TUMBLEWEED LN
SQUAW VALLEY CA
93675-9012
US

IV. Provider business mailing address

32036 TUMBLEWEED LN
SQUAW VALLEY CA
93675-9012
US

V. Phone/Fax

Practice location:
  • Phone: 559-908-1676
  • Fax:
Mailing address:
  • Phone: 559-908-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23930
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: