Healthcare Provider Details

I. General information

NPI: 1609327667
Provider Name (Legal Business Name): PSYCHHEALING COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N BEGONIA AVE STE 1009
ONTARIO CA
91762-2104
US

IV. Provider business mailing address

1011 N BEGONIA AVE STE 1009
ONTARIO CA
91762-2104
US

V. Phone/Fax

Practice location:
  • Phone: 800-683-2945
  • Fax: 909-906-2017
Mailing address:
  • Phone: 800-683-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28271
License Number StateCA

VIII. Authorized Official

Name: DR. NHUNG TUYET PHAN
Title or Position: PSYCHOLOGIST
Credential:
Phone: 800-683-2945