Basic Information
| Provider Information | |||||||||
| NPI: | 1215673595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIREYA TORRES, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15555 MAIN ST. | ||||||||
| Address2: | SUITE D4 PMB 148 | ||||||||
| City: | HESPERIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92345 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15437 ANACAPA RD STE 29 | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923922458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609989095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | MIREYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7605590384 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.