Healthcare Provider Details

I. General information

NPI: 1316630114
Provider Name (Legal Business Name): LA PAZ COUNSELING & THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 W HAMMER LN STE B
STOCKTON CA
95209-2752
US

IV. Provider business mailing address

PO BOX 693133
STOCKTON CA
95269-3133
US

V. Phone/Fax

Practice location:
  • Phone: 209-440-0143
  • Fax:
Mailing address:
  • Phone: 209-440-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. IMELDA DONATO
Title or Position: FOUNDER
Credential: LPCC
Phone: 209-440-0143