Healthcare Provider Details

I. General information

NPI: 1669342713
Provider Name (Legal Business Name): YEBOAH MARRIAGE & FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W REDLANDS BLVD STE J
REDLANDS CA
92373-8032
US

IV. Provider business mailing address

1630 W REDLANDS BLVD STE J
REDLANDS CA
92373-8032
US

V. Phone/Fax

Practice location:
  • Phone: 909-352-4912
  • Fax:
Mailing address:
  • Phone: 909-352-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JEANETTA LATRICE YOUNG-YEBOAH
Title or Position: CEO
Credential: LMFT
Phone: 909-352-4912