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General NPI Number Information
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NPI Number | 1649990870
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Entity Type | Organization
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Legal Business Name | DE LA VEGA COUNSELING SERVICES
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 14181 YORBA ST STE 206
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City | TUSTIN
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State | CA
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Zip | 92780-2055
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Country | US
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Telephone | 190-947-7700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1176
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City | WHITTIER
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State | CA
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Zip | 90609-1176
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Country | US
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Telephone | 909-477-7005
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | KIMBERLY C DE LA VEGA
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Credential | LMFT 125331
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Telephone | 909-477-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 |
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License Number State |
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