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General NPI Number Information
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NPI Number | 1013613058
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Entity Type | Organization
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Legal Business Name | YOUTHFUL CREATIONS AND INTERVENTIONS
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 3667 N PLUM TREE AVE
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City | RIALTO
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State | CA
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Zip | 92377-2701
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Country | US
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Telephone | 909-543-9974
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Fax |
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Provider Business Mailing Address
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Address Line | 3667 N PLUM TREE AVE
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City | RIALTO
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State | CA
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Zip | 92377-2701
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Country | US
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Telephone | 909-543-9974
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRY D ROSEBOROUGH
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Credential |
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Telephone | 909-543-9974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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