1346855749 NPI number — 4 WINDS CULTURAL COUNSELING & WELLNESS CENTER, LICENSED CLINICAL SOCIAL WORKER, INC.

Table of content: (NPI 1346855749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346855749 NPI number — 4 WINDS CULTURAL COUNSELING & WELLNESS CENTER, LICENSED CLINICAL SOCIAL WORKER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
4 WINDS CULTURAL COUNSELING & WELLNESS CENTER, LICENSED CLINICAL SOCIAL WORKER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1346855749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12536 PENSKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92553-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-965-0619
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3742 TIBBETTS ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-458-6932
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LAMADRID
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
CARLOS
Authorized Official Title or Position:
OWNER/FOUNDER
Authorized Official Telephone Number:
951-965-0619

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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