Provider Demographics
NPI:1679707418
Name:ACOBA, REYNO BUTCH RADOC (LMFT)
Entity type:Individual
Prefix:MR
First Name:REYNO BUTCH
Middle Name:RADOC
Last Name:ACOBA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22003 S VERMONT AVE APT 30
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2123
Mailing Address - Country:US
Mailing Address - Phone:562-212-6859
Mailing Address - Fax:714-670-6220
Practice Address - Street 1:2301 E 28TH ST STE 309
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90755-2181
Practice Address - Country:US
Practice Address - Phone:562-212-6859
Practice Address - Fax:714-670-6220
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist