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General NPI Number Information
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NPI Number | 1114251626
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Entity Type | Individual
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Provider Name | DENISE C FANELLI MA, ATR, LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 3020 OLD RANCH PARKWAY SUITE 100
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 714-394-7266
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Fax | 562-596-6024
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Provider Business Mailing Address
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Address Line | 3020 OLD RANCH PARKWAY SUITE 100
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 714-394-7266
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Fax | 562-596-6024
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MY23409
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC23409
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License Number State | CA
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