Healthcare Provider Details

I. General information

NPI: 1740673144
Provider Name (Legal Business Name): WILLIAM ROOZEBOOM PHD, AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 HAVEN AVE STE 240
RANCHO CUCAMONGA CA
91730-8551
US

IV. Provider business mailing address

9220 HAVEN AVE STE 240
RANCHO CUCAMONGA CA
91730-8551
US

V. Phone/Fax

Practice location:
  • Phone: 909-257-8461
  • Fax:
Mailing address:
  • Phone: 909-257-8461
  • 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 Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: