Provider Demographics
NPI:1194058297
Name:ARELLANO, LUIS JR (LCSW)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ARELLANO
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-3051
Mailing Address - Country:US
Mailing Address - Phone:909-731-1739
Mailing Address - Fax:
Practice Address - Street 1:6601 STEPHENS RANCH RD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1146
Practice Address - Country:US
Practice Address - Phone:909-593-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31286101YM0800X
CALCSW76106101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health