1649594409 NPI number — COMPLETE COUNSELING SERVICES, INC

Table of content: (NPI 1649594409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649594409 NPI number — COMPLETE COUNSELING SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE COUNSELING SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649594409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14954 WESTFORK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92336-0746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-234-8880
Provider Business Mailing Address Fax Number:
909-482-2211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 W 1ST ST STE 242
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91711-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-234-8880
Provider Business Practice Location Address Fax Number:
909-482-2211
Provider Enumeration Date:
03/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GAJIC
Authorized Official First Name:
DRAGANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO OWNER
Authorized Official Telephone Number:
909-234-8880

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  25965 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com