Healthcare Provider Details

I. General information

NPI: 1316608482
Provider Name (Legal Business Name): WEBER COUNSELING SERVICES A LICENSED CLINICAL SOCIAL WORKER PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N MAIN ST STE 127
CORONA CA
92878-1440
US

IV. Provider business mailing address

1460 PASO FINO PL
NORCO CA
92860-3931
US

V. Phone/Fax

Practice location:
  • Phone: 951-751-9636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JODI BENNETT
Title or Position: BILLING MANAGER
Credential:
Phone: 951-423-2202