=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043977945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE ESCAPE MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2021
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13261 SPRING VALLEY PRKWY 203
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 442-243-2714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8958 SVL BOX
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395-5132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-801-0119
-----------------------------------------------------
Fax | 442-327-9151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MERCEDES DENISE GREEN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 951-801-0119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------