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General NPI Number Information
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NPI Number | 1225831670
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Entity Type | Organization
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Legal Business Name | GUIDED LIFE THERAPEUTICS
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 600 N EUCLID AVE STE 103
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City | UPLAND
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State | CA
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Zip | 91786-4779
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Country | US
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Telephone | 747-218-1622
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N EUCLID AVE STE 103
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City | UPLAND
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State | CA
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Zip | 91786-4779
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Country | US
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Telephone | 747-218-1622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE CAROLE BOULWARE
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Credential | LMFT
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Telephone | 626-506-6265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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