Individual
ANA LISA DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1107 REAM AVE, MOUNT SHASTA, CA 96067-9768
(530) 926-1436
Mailing address
1107 REAM AVE, MOUNT SHASTA, CA 96067-9768
(530) 926-1436
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/20/2007
Last updated
03/13/2008
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