Healthcare Provider Details

I. General information

NPI: 1588868251
Provider Name (Legal Business Name): EAST VALLEY CHARLEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD SUITE 285
REDLANDS CA
92373
US

IV. Provider business mailing address

101 E REDLANDS BLVD SUITE 285
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-5777
  • Fax: 909-307-5776
Mailing address:
  • Phone: 909-307-5777
  • Fax: 909-307-5776

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: TINA MARIE COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 909-307-5777