Provider Demographics
NPI:1184063042
Name:JUAREZ, TONALLI (MA, LPCC)
Entity type:Individual
Prefix:
First Name:TONALLI
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16854
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-6854
Mailing Address - Country:US
Mailing Address - Phone:702-423-6554
Mailing Address - Fax:
Practice Address - Street 1:6401 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7319
Practice Address - Country:US
Practice Address - Phone:858-290-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8684OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR