Basic Information
| Provider Information | |||||||||
| NPI: | 1821108374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | XAYARATH | ||||||||
| FirstName: | NOVANH | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4208 GILES CT | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513547350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9990 COUNTY FARM RD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513584840 | ||||||||
| FaxNumber: | 3513584848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 39607 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.