Individual
IVY JANET PALENCIA DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2610 INDUSTRY WAY, LYNWOOD, CA 90262-4283
(310) 667-4070
Mailing address
2610 INDUSTRY WAY, LYNWOOD, CA 90262-4283
(310) 667-4070
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPCC7674
CA
101YP2500X
Professional Counselor
PCCI: 1879
CA
Other
Enumeration date
10/08/2012
Last updated
05/15/2020
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