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General NPI Number Information
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NPI Number | 1891345310
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Entity Type | Individual
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Provider Name | KONNOR FEESE MS, LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 208 S NEBRASKA ST
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-1894
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Country | US
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Telephone | 714-356-7066
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 SAN GABRIEL WAY UNIT 106
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City | CORONA
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State | CA
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Zip | 92882-8034
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Country | US
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Telephone | 512-235-5899
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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 | 114201
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License Number State | CA
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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 | LMFT121564
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License Number State | CA
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