Basic Information
| Provider Information | |||||||||
| NPI: | 1023162690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMOUREUX | ||||||||
| FirstName: | IMELDA | ||||||||
| MiddleName: | CUEVAS | ||||||||
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| Credential: | MS, PPS SCHOOL PSYCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 742 CUMBERLAND DR | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259387059 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1026 OAK GROVE RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945183289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256465468 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.