Healthcare Provider Details

I. General information

NPI: 1831707702
Provider Name (Legal Business Name): DLZ PSYCHOTHERAPY & FAMILY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 ORANGE TREE LN STE 200
REDLANDS CA
92374-2800
US

IV. Provider business mailing address

1902 ORANGE TREE LN STE 200
REDLANDS CA
92374-2800
US

V. Phone/Fax

Practice location:
  • Phone: 99-798-6210
  • Fax:
Mailing address:
  • Phone: 99-798-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BRANDON ZINKE
Title or Position: CEO
Credential: LCSW
Phone: 909-969-4941