Provider Demographics
NPI:1528444296
Name:DESOUZA-WALDEN, EUCIANE LELIS (LMFT)
Entity type:Individual
Prefix:
First Name:EUCIANE
Middle Name:LELIS
Last Name:DESOUZA-WALDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:EUCIANE
Other - Middle Name:LELIS
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EUCIANE SOUZA
Mailing Address - Street 1:713 ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4803
Mailing Address - Country:US
Mailing Address - Phone:805-607-6543
Mailing Address - Fax:
Practice Address - Street 1:713 ARBOR AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4803
Practice Address - Country:US
Practice Address - Phone:805-607-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist