Provider Demographics
NPI:1073956348
Name:UCEDA, LUIS ROBERT (MA LPC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ROBERT
Last Name:UCEDA
Suffix:
Gender:
Credentials:MA LPC
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:UCEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC LAC
Mailing Address - Street 1:2801 MAIN ST APT 356
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5016
Mailing Address - Country:US
Mailing Address - Phone:949-299-7385
Mailing Address - Fax:
Practice Address - Street 1:2801 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5027
Practice Address - Country:US
Practice Address - Phone:949-299-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016782101YM0800X
CO0000293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health