Healthcare Provider Details

I. General information

NPI: 1578206686
Provider Name (Legal Business Name): VILLASENOR COUNSELING: INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, A PROF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAKES DR STE 225
WEST COVINA CA
91790-2910
US

IV. Provider business mailing address

1050 LAKES DR STE 225
WEST COVINA CA
91790-2910
US

V. Phone/Fax

Practice location:
  • Phone: 323-977-8849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE VILLASENOR
Title or Position: OWNER
Credential:
Phone: 661-342-9986