Healthcare Provider Details

I. General information

NPI: 1205451671
Provider Name (Legal Business Name): MERCEDES ELAINE TOLENTINO AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

815 9TH ST
MARYSVILLE CA
95901-5216
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax:
Mailing address:
  • Phone: 530-588-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22069
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: