=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407058167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESIRAE TORRENS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 W JOAQUIN AVE STE 110
-----------------------------------------------------
City | SAN LEANDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-878-9709
-----------------------------------------------------
Fax | 510-225-2570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 W JOAQUIN AVE STE 110
-----------------------------------------------------
City | SAN LEANDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94577-3667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-878-9709
-----------------------------------------------------
Fax | 510-225-2570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 53874
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------