Healthcare Provider Details

I. General information

NPI: 1659193100
Provider Name (Legal Business Name): STRENGTHS BASED FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LONG BEACH AVE
CEDARPINES PARK CA
92322-0133
US

IV. Provider business mailing address

PO BOX 9226
CEDARPINES PARK CA
92322-9226
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-5807
  • Fax:
Mailing address:
  • Phone: 909-338-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOANNA SLUSSER
Title or Position: CHIEF OF STAFF
Credential:
Phone: 909-522-1487