Healthcare Provider Details

I. General information

NPI: 1043032188
Provider Name (Legal Business Name): MARISOL HERRERA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

IV. Provider business mailing address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3300
  • Fax: 707-463-3318
Mailing address:
  • Phone: 707-463-3300
  • Fax: 707-463-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: