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General NPI Number Information
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NPI Number | 1043978570
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Entity Type | Organization
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Legal Business Name | TRINITY THRIVE MARRIAGE AND FAMILY THERAPY CENTER, INC
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 358 E BONITA AVE STE B
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City | SAN DIMAS
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State | CA
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Zip | 91773-3172
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Country | US
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Telephone | 909-413-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 358 E BONITA AVE STE B
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City | SAN DIMAS
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State | CA
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Zip | 91773-3172
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Country | US
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Telephone | 909-413-4814
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANETTE LUNA
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Credential |
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Telephone | 909-579-7420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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