| Doctor Name: | MRS. NIDIA DELSY PRAVONGVIENGKHAM |
| NPI Number: | 1235384066 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | IMF 54676 |
| Business Practice Address: | 13800 Heacock St Ste C236 Moreno Valley, CA - 925533364 |
| Business Phone Number: | 9516530819 |
| Business Fax Number: | |
| Mailing Address: | 13415 Canterbury Downs Way, MORENO VALLEY |
| State: | CA |
| Postal Code: | 925558402 |
| Phone Number: | 9518930089 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2008 |
| NPI Last Update Date: | 11/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 106H00000X |
| License Number: | IMF 54676 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Marriage & Family Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |