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General NPI Number Information
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NPI Number | 1376688077
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Entity Type | Individual
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Provider Name | CLEMENT MILES LUCERO M.A., MFT, INTERN
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 58945 BUSINESS CENTER DR. #D
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7307
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Country | US
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Telephone | 760-228-9657
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Fax |
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Provider Business Mailing Address
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Address Line | 7696 BORREGO TRAIL
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-6374
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Country | US
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Telephone | 760-808-4517
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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 | IMF64396
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License Number State | CA
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