Healthcare Provider Details

I. General information

NPI: 1992587638
Provider Name (Legal Business Name): FOUR ELEMENTS MARRIAGE AND FAMILY COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28441 RANCHO CALIFORNIA RD STE 207
TEMECULA CA
92590-3677
US

IV. Provider business mailing address

28441 RANCHO CALIFORNIA RD STE 207
TEMECULA CA
92590-3677
US

V. Phone/Fax

Practice location:
  • Phone: 951-519-9105
  • Fax:
Mailing address:
  • Phone: 951-519-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEE PADDEN
Title or Position: PRESIDENT, CEO
Credential: M.A., LMFT
Phone: 951-519-9105