Nicole Renae Cuahutle
Individual provider Active NPI Marriage & Family Therapist · Walnut, CA
NPI 1104489210 · NPPES record last updated Jul 26, 2022
Key facts
- NPI
- 1104489210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- Practice address
- 20549 Valley Blvd
Walnut, CA 91789-2730 - Phone
- (809) 594-2762
- NPI assigned
- Apr 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250529001586 | CA | Practitioner - Marriage and Family Therapist | 8527587831 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT120879 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Talk Therapy Center | Marriage & Family Therapist | Current |
Accepting new patients |
| Institute for the Redesign of Learning | Mental Health | Past |
Accepting new patients |
Locations
19322 Jesse Ln
Ste 200
Riverside, CA 92508
Phone (951) 387-4040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | AMFT120879 | CA | |
| Marriage & Family Therapist | 106H00000X | Yes |
Addresses
Primary practice location
20549 Valley Blvd
Walnut, CA 91789-2730
Mailing address
205 Pasadena Ave
South Pasadena, CA 91030-2919
Phone (323) 344-5536
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7708 | Other | CA | MEDI-CAL |
| 7667 | Other | CA | MEDI-CAL |
| 7184 | Other | CA | MEDI-CAL |
| 7368 | Other | CA | MEDI-CAL |
Other providers in Walnut, CA
- Bonita Louise Conway
- Russell Cook
- Ramon Coronado
- Vanessa Cortez
- Cynthia Cruz-Porto
- Kyle Dalan
- Jamie Daniels
- David Pace D.D.S. Inc.
- Laurentino Lozada De Guia Jr.
- Concepcion De Guzman
All providers in Walnut, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.