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General NPI Number Information
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NPI Number | 1265165583
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Entity Type | Organization
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Legal Business Name | LIFE BUILDERS FAMILY COUNSELING CORP.
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 11175 AZUSA CT STE 110
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4933
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Country | US
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Telephone | 626-469-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 10808 FOOTHILL BLVD STE 160-154
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3889
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Country | US
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Telephone | 626-469-1158
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CLINICIAN
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Name | JASON BETTS
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Credential | LMFT#128533
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Telephone | 626-298-2865
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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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