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General NPI Number Information
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NPI Number | 1356997290
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Entity Type | Individual
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Provider Name | LAURENA PHAM LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 9265 SKY PARK CT STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92123-4375
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Country | US
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Telephone | 844-737-3638
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Fax | 619-403-9496
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Provider Business Mailing Address
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Address Line | 3100 BIG DALTON AVE STE 170
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5136
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Country | US
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Telephone | 626-671-9651
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT146565
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License Number State | CA
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