MEDICARE: ASSOCIATED CLINICAL THERAPISTS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	LCS20302	CA

General Provider Information

NPI Number	:	1982974770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED CLINICAL THERAPISTS, INC

Provider Business Mailing Address
First Line	:	7211 HAVEN AVE # E327
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-6064
Country	:	US
Telephone Number	:	800-994-2535
Fax Number	:	866-724-1504

Provider Business Practice Location Address
First Line	:	7828 HAVEN AVE # 102
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3049
Country	:	US
Telephone Number	:	800-994-2535
Fax Number	:	866-724-1504

Authorized Official
Title or Position	:	OWNER,PRESIDENT,PSYCHOTHERAPIST
Name	:	MRS. RACHEL MICHELLE ESTRADA
Credential	:	MSW, LCSW, DCSW
Telephone Number	:	800-994-2535

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/10/2012

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