Basic Information
| Provider Information | |||||||||
| NPI: | 1013408236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | EVANGELINA | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 E CARSON PLAZA DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907463271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105239500 | ||||||||
| FaxNumber: | 3102252725 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 E CARSON PLAZA DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105239500 | ||||||||
| FaxNumber: | 3102252725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | AMFT98357 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | LMFT114918 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.