Healthcare Provider Details

I. General information

NPI: 1861938722
Provider Name (Legal Business Name): MERRELL FAMILY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 CARNELIAN ST STE 240
RANCHO CUCAMONGA CA
91730-1136
US

IV. Provider business mailing address

7365 CARNELIAN ST STE 240
RANCHO CUCAMONGA CA
91730-1136
US

V. Phone/Fax

Practice location:
  • Phone: 909-281-1557
  • Fax: 877-850-5695
Mailing address:
  • Phone: 909-281-1557
  • Fax: 877-850-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACEY MERRELL
Title or Position: PRESIDENT
Credential: LMFT
Phone: 951-218-0951