Healthcare Provider Details

I. General information

NPI: 1386558906
Provider Name (Legal Business Name): COMMUNITY MINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 HAVEN AVE STE 110
RANCHO CUCAMONGA CA
91730-5429
US

IV. Provider business mailing address

9065 HAVEN AVE STE 110
RANCHO CUCAMONGA CA
91730-5429
US

V. Phone/Fax

Practice location:
  • Phone: 909-757-5770
  • Fax:
Mailing address:
  • Phone: 909-757-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASMINE DEGUZMAN
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: LMFT
Phone: 909-757-5770