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General NPI Number Information
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NPI Number | 1306140090
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Entity Type | Individual
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Provider Name | KARINA FUENTES LMFT 123490
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 1255 KENDALL RD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8750
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Country | US
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Telephone | 805-602-7468
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 KENDALL RD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8750
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Country | US
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Telephone | 805-602-7468
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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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 | 118813
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 123490
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License Number State | CA
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