Basic Information
| Provider Information | |||||||||
| NPI: | 1609331248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORTEZ | ||||||||
| FirstName: | ANGELITA | ||||||||
| MiddleName: | DOMINIQUE | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | HEALTHY MINDS COUNSELING SERVICES | ||||||||
| Address2: | 591 CAMINO DE LA REINA, SUITE 210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192065271 | ||||||||
| FaxNumber: | 6197953274 | ||||||||
| Practice Location | |||||||||
| Address1: | HEALTHY MINDS COUNSELING SERVICES | ||||||||
| Address2: | 591 CAMINO DE LA REINA, SUITE 210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192065271 | ||||||||
| FaxNumber: | 6197953274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2019 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6037 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.