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General NPI Number Information
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NPI Number | 1033612783
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Entity Type | Organization
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Legal Business Name | VIDA COUNSELING SERVICES
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 2900 ADAMS ST STE B30-16
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City | RIVERSIDE
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State | CA
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Zip | 92504-8311
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Country | US
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Telephone | 951-220-8607
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Fax | 951-220-8607
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Provider Business Mailing Address
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Address Line | 2900 ADAMS ST STE B30-16
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City | RIVERSIDE
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State | CA
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Zip | 92504-8311
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Country | US
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Telephone | 951-220-8607
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Fax | 951-220-8607
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Authorized Official
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Title or Position | OWNER
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Name | MR. LUIS RESENDEZ JR.
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Credential | M.A.
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Telephone | 951-220-8607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMFT86942
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License Number State | CA
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