=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871307199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LETISSA VALENTINE-CELINDRO LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2025
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 2583
-----------------------------------------------------
City | CAPISTRANO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92624-0583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-444-9626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2583
-----------------------------------------------------
City | CAPISTRANO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92624-0583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 151920
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------