Tiffany Renee Agra
Marriage & Family Therapist in Lake Forest, CA. Individual provider (NPI-1).
NPI number1770813743
StatusActive
Last updated in NPPESJul 31, 2019
Details
- NPI
- 1770813743
- Entity type
- Individual (NPI-1)
- Name
- Tiffany Renee Agra
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 13, 2010
- Last updated
- Jul 31, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 103693 | CA | Yes |
Practice location
23832 Rockfield Blvd Ste 120Lake Forest, CA 92630-2870
Phone 949-767-6396
Mailing address
23832 Rockfield Blvd Ste 120Lake Forest, CA 92630-2870
Phone 949-767-6396
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