Healthcare Provider Details

I. General information

NPI: 1285185058
Provider Name (Legal Business Name): CAUDILLO-COLE THERAPEUTIKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N 3RD AVE SUITE N
UPLAND CA
91786-6052
US

IV. Provider business mailing address

167 N 3RD AVE SUITE N
UPLAND CA
91786-6052
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-0007
  • Fax:
Mailing address:
  • Phone: 213-700-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLMFT32933
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD CREIGHTON COLE I
Title or Position: DIRECTOR/FOUNDER/PRESIDENT
Credential: PHD/LMFT
Phone: 213-700-0007