Healthcare Provider Details

I. General information

NPI: 1497379267
Provider Name (Legal Business Name): SIMPLE SOLUTIONS FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ARCHIBALD AVE STE 110
RANCHO CUCAMONGA CA
91730-3670
US

IV. Provider business mailing address

8350 ARCHIBALD AVE STE 110
RANCHO CUCAMONGA CA
91730-3670
US

V. Phone/Fax

Practice location:
  • Phone: 909-660-3624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANIYYAH MAYO
Title or Position: CEO/FOUNDER
Credential: LMFT
Phone: 909-678-5273