Most Relevant Information
Provider Data
| NPI Number: | 1003011701 |
| Provider Name: | CORENE VIEIRA TAGUE M.A. |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 42054 |
Most Important Dates
| Enumeration Date: | 06/20/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
11301 ACACIA PKWY
FAMILY AND YOUTH OUTREACH PROGRAM
GARDEN GROVE
CA
928405310
Practice Location Phone/Fax
| Phone: | 7147415888 |
| Fax: | 7146360351 |
Provider Mailing Location
PO BOX 541
HUNTINGTON BEACH
CA
926480541
Provider Mailing Phone/Fax
| Phone: | 7144571614 |
| Fax: |