Provider Demographics
NPI:1720489065
Name:EBNEOF, VENECIA (MFT)
Entity type:Individual
Prefix:
First Name:VENECIA
Middle Name:
Last Name:EBNEOF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39281 VIA PAMPLONA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5023
Mailing Address - Country:US
Mailing Address - Phone:951-319-5293
Mailing Address - Fax:
Practice Address - Street 1:39281 VIA PAMPLONA
Practice Address - Street 2:MURRIETA
Practice Address - City:CA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-319-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101298101YM0800X
81698106H00000X
CALMFT101298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health