Basic Information
| Provider Information | |||||||||
| NPI: | 1083198782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 591 CAMINO DE LA REINA STE 802 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585198002 | ||||||||
| FaxNumber: | 6196843788 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 CAMINO DE LA REINA STE 802 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585198002 | ||||||||
| FaxNumber: | 6196843788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | VILLASENOR | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
| AuthorizedOfficialMiddleName: | DANIELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8585198002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1699020644 | 01 | CA | NPI | OTHER | 1942653332 | 01 | CA | NPI | OTHER | 1285844456 | 01 | CA | NPI | OTHER |