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General NPI Number Information
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NPI Number | 1902401714
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Entity Type | Individual
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Provider Name | JUSTINE COLLAZO LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 18000 STUDEBAKER RD STE 700
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City | CERRITOS
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State | CA
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Zip | 90703-2684
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Country | US
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Telephone | 310-864-0516
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 MAPLE AVE APT 49
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City | TORRANCE
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State | CA
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Zip | 90503-7125
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Country | US
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Telephone | 310-626-3854
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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 | 119202
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License Number State | CA
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