Healthcare Provider Details

I. General information

NPI: 1285073767
Provider Name (Legal Business Name): BUSINESS CONSULTATION AND MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 1ST ST
CLAREMONT CA
91711-4736
US

IV. Provider business mailing address

PO BOX 492
CLAREMONT CA
91711-0492
US

V. Phone/Fax

Practice location:
  • Phone: 909-263-5799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY24675
License Number StateCA

VIII. Authorized Official

Name: DR. MARISSA LONG
Title or Position: PSYCHOLOGIST/ CONSULTANT
Credential: M.A.O.B., PSY.D.
Phone: 909-263-5799