Healthcare Provider Details

I. General information

NPI: 1407446123
Provider Name (Legal Business Name): SOCIAL RESOURCES NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23945 SUNNYMEAD BLVD STE 3
MORENO VALLEY CA
92553-3025
US

IV. Provider business mailing address

11019 REICHLING LN
WHITTIER CA
90606-1508
US

V. Phone/Fax

Practice location:
  • Phone: 562-200-4381
  • Fax: 951-346-4117
Mailing address:
  • Phone: 562-200-4381
  • Fax: 951-346-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TELANA MONE COURSEAULT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 562-200-4381