Healthcare Provider Details

I. General information

NPI: 1619366952
Provider Name (Legal Business Name): HUMANISTIC COUNSELING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12016 VISTA DE CERROS DR
MORENO VALLEY CA
92555-1813
US

IV. Provider business mailing address

12016 VISTA DE CERROS DR
MORENO VALLEY CA
92555-1813
US

V. Phone/Fax

Practice location:
  • Phone: 909-229-4312
  • Fax:
Mailing address:
  • Phone: 909-229-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberLCS9548
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCS9548
License Number StateCA

VIII. Authorized Official

Name: MS. BRENDA M REESE
Title or Position: DIRECTOR
Credential: BA, MSW, LCSW
Phone: 909-229-4312