Healthcare Provider Details

I. General information

NPI: 1043727886
Provider Name (Legal Business Name): MARSELL CONSULTING AND MHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 E GUASTI RD STE 700
ONTARIO CA
91761
US

IV. Provider business mailing address

3281 E GUASTI RD STE 700
ONTARIO CA
91761-7643
US

V. Phone/Fax

Practice location:
  • Phone: 909-212-7643
  • Fax: 909-456-8094
Mailing address:
  • Phone: 909-212-7643
  • Fax: 909-456-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTINEZ I SELLERS
Title or Position: OWNER
Credential:
Phone: 909-743-1308