Provider Demographics
NPI:1215666482
Name:FUENTES MARRIAGE AND FAMILY THERAPY PRACTICES, INC.
Entity type:Organization
Organization Name:FUENTES MARRIAGE AND FAMILY THERAPY PRACTICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SUPERVISOR, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW-FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PMH-C
Authorized Official - Phone:949-484-5008
Mailing Address - Street 1:1821 W BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7122
Mailing Address - Country:US
Mailing Address - Phone:714-478-4607
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:949-484-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty