Healthcare Provider Details

I. General information

NPI: 1174231385
Provider Name (Legal Business Name): CONNECTIONS FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27851 BRADLEY RD STE 130C
MENIFEE CA
92586-2282
US

IV. Provider business mailing address

27851 BRADLEY RD STE 130C
MENIFEE CA
92586-2282
US

V. Phone/Fax

Practice location:
  • Phone: 951-355-5772
  • Fax: 951-430-4729
Mailing address:
  • Phone: 951-355-5772
  • Fax: 951-430-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA ASHLEE TRIGUEROS-THURSTON
Title or Position: PRESIDENT/THERAPIST
Credential: LMFT
Phone: 661-414-2433