Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 130100488 | CA |
NPI | 1124519095 |
---|---|
Provider Name | Martha Elena Campos |
First Address | Santa Ana, CA 92701-3943 |
Second Address | Santa Ana, CA 92701-3943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104628 | LICENSED MARRIAGE AND FAMILY THERAPIST (01) | CA |