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General NPI Number Information
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NPI Number | 1255449708
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Entity Type | Organization
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Legal Business Name | GATEWAY COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 12712 HEACOCK ST STE 6
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3037
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Country | US
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Telephone | 951-768-1535
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Fax | 866-896-6067
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Provider Business Mailing Address
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Address Line | 3576 ARLINGTON AVE STE 307
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City | RIVERSIDE
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State | CA
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Zip | 92506-3988
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Country | US
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Telephone | 951-768-1535
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Fax | 866-896-6067
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACK LAWRENCE JOHNSON
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Credential | MFT
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Telephone | 951-768-1535
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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 | MFC-24968
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License Number State | CA
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