Healthcare Provider Details

I. General information

NPI: 1972435196
Provider Name (Legal Business Name): TWELVE TWO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N EUCLID AVE
ONTARIO CA
91762-3535
US

IV. Provider business mailing address

13230 WINSLOW DR
RANCHO CUCAMONGA CA
91739-9271
US

V. Phone/Fax

Practice location:
  • Phone: 909-477-1910
  • Fax:
Mailing address:
  • Phone: 909-477-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ATHENA OBRIEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 909-477-1910