Basic Information
| Provider Information | |||||||||
| NPI: | 1205965639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARO | ||||||||
| FirstName: | RAUL | ||||||||
| MiddleName: | GRACIA | ||||||||
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| Credential: | MFT INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 W ALAMEDA AVE APT B | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915062836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184216022 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9101 WHITTIER BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906602405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628014626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 51823 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.