Healthcare Provider Details

I. General information

NPI: 1568286383
Provider Name (Legal Business Name): SUNSET COAST FAMILY THERAPY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25386 PINE RIDGE RD
HOMELAND CA
92548-3260
US

IV. Provider business mailing address

25386 PINE RIDGE RD
HOMELAND CA
92548-3260
US

V. Phone/Fax

Practice location:
  • Phone: 951-551-5225
  • Fax:
Mailing address:
  • Phone: 951-551-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HENSON
Title or Position: CEO/OWNER
Credential: LMFT 143459
Phone: 951-551-5225