Healthcare Provider Details

I. General information

NPI: 1649990870
Provider Name (Legal Business Name): DE LA VEGA COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14181 YORBA ST STE 206
TUSTIN CA
92780-2055
US

IV. Provider business mailing address

PO BOX 1176
WHITTIER CA
90609-1176
US

V. Phone/Fax

Practice location:
  • Phone: 190-947-7700
  • Fax:
Mailing address:
  • Phone: 909-477-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY C DE LA VEGA
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT 125331
Phone: 909-477-7005