MEDICARE: LEMONADE COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790359990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEMONADE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	14068 GRAHAM ST STE 202
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8830
Country	:	US
Telephone Number	:	562-704-6779
Fax Number	:	562-207-5166

Provider Business Practice Location Address
First Line	:	14068 GRAHAM ST STE 202
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8830
Country	:	US
Telephone Number	:	562-704-6779
Fax Number	:	562-207-5166

Authorized Official
Title or Position	:	OWNER
Name	:	CORRDERO TAYLOR
Credential	:	LCSW
Telephone Number	:	310-956-8810

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	08/09/2022

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Directions to “LEMONADE COUNSELING SERVICES ” Practice Location

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