Healthcare Provider Details

I. General information

NPI: 1871012203
Provider Name (Legal Business Name): HEALING HEARTS MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 CENTRAL AVE STE 400
RIVERSIDE CA
92506-5907
US

IV. Provider business mailing address

3870 LA SIERRA AVE # 192
RIVERSIDE CA
92505-3528
US

V. Phone/Fax

Practice location:
  • Phone: 951-285-0510
  • Fax: 951-552-1647
Mailing address:
  • Phone: 951-285-0510
  • Fax: 951-552-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLMFT86368
License Number StateCA

VIII. Authorized Official

Name: MRS. TERESA ALVARADO
Title or Position: PRESIDENT
Credential: LMFT
Phone: 951-285-0510