Provider Demographics
NPI:1679958151
Name:ADAMS, MARISELA
Entity type:Individual
Prefix:MRS
First Name:MARISELA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARISELA
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2531 REDLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4021
Mailing Address - Country:US
Mailing Address - Phone:951-809-8429
Mailing Address - Fax:
Practice Address - Street 1:5055 CANYON CREST DR STE 1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6015
Practice Address - Country:US
Practice Address - Phone:951-623-3460
Practice Address - Fax:760-645-3268
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47-4615477106H00000X
CA77746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist