=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013516350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANCE J JOHNS MARRIAGE AND FAMILY THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2020
-----------------------------------------------------
Last Update Date | 04/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 9TH ST STE 100-173
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-654-5992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 W COLTON AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-654-5992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LANCE JOHNS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-271-6356
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------