Healthcare Provider Details

I. General information

NPI: 1356918320
Provider Name (Legal Business Name): YOU ARE A MASTERPIECE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4552 JEREMIAH CT
RIVERSIDE CA
92503-2662
US

IV. Provider business mailing address

4552 JEREMIAH CT
RIVERSIDE CA
92503-2662
US

V. Phone/Fax

Practice location:
  • Phone: 310-386-7357
  • Fax:
Mailing address:
  • Phone: 310-386-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARICELA DIAZ
Title or Position: OWNER/FOUNDER
Credential: LMFT, LPCC
Phone: 310-386-7357