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General NPI Number Information
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NPI Number | 1174728828
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Entity Type | Organization
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Legal Business Name | WILLMON FAMILY COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5464 GRASSY TRAIL DR
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City | RIVERSIDE
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State | CA
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Zip | 92504-1214
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Country | US
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Telephone | 951-369-0439
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Fax |
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Provider Business Mailing Address
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Address Line | 3590 CENTRAL AVE SUITE 208
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City | RIVERSIDE
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State | CA
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Zip | 92506-2708
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Country | US
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Telephone | 951-320-1390
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Fax | 951-684-4538
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LISA ANNE WILLMON
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Credential | M.A., MFT
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Telephone | 951-320-1390
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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 | 28565
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License Number State | CA
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