Therese Mignon Clemente, MFT

Individual provider Active NPI Marriage & Family Therapist · Montrose, CA

NPI 1013573161 · NPPES record last updated May 14, 2019

Key facts

NPI
1013573161
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
LMFT110257 (CA)
Practice address
2550 Honolulu Ave Ste 107
Montrose, CA 91020-1859
Phone
(818) 800-0279
NPI assigned
May 14, 2019
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LMFT110257CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Resilience Counseling Center Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT110257 CA Yes

Addresses

Primary practice location

2550 Honolulu Ave Ste 107
Montrose, CA 91020-1859

Mailing address

5928 Graciosa Dr
Los Angeles, CA 90068-3031
Phone (323) 271-8387

Other providers in Montrose, CA

All providers in Montrose, CA · Marriage & Family Therapist in California

Sources for this page

Verify at the official NPI Registry.