1225662885 NPI number — SAFE HARBOR CATHOLIC COUNSELING INSTITUTE

Table of content: (NPI 1225662885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225662885 NPI number — SAFE HARBOR CATHOLIC COUNSELING INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFE HARBOR CATHOLIC COUNSELING INSTITUTE
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:
6
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:
1225662885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13149 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-342-6681
Provider Business Mailing Address Fax Number:
909-413-0241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13149 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-342-6681
Provider Business Practice Location Address Fax Number:
909-413-0241
Provider Enumeration Date:
02/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA REYES
Authorized Official First Name:
ROCIO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-342-6681

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100208 . This is a "LICENSE LIFE MARRIED FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 116288 . This is a "LICENSE LIFE MARRIED FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 86375 . This is a "LICENSE LIFE MARRIED FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AMFT105366 . This is a "LICENSE LIFE MARRIAGE FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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