Healthcare Provider Details

I. General information

NPI: 1174089411
Provider Name (Legal Business Name): FAMILY TALK THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19322 JESSE LN STE 100 AND 200
RIVERSIDE CA
92508-5091
US

IV. Provider business mailing address

19322 JESSE LN STE 200
RIVERSIDE CA
92508-5072
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-4040
  • Fax: 951-398-3144
Mailing address:
  • Phone: 951-387-4040
  • Fax: 951-398-3144

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: MR. JASON SCOTT TEMPLE SR.
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 951-387-4040