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General NPI Number Information
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NPI Number | 1265301303
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Entity Type | Organization
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Legal Business Name | GENTLE ROOTS THERAPEUTIC SERVICES, LICENSED CLINICAL SOCIAL WORKER, AP
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 7365 CARNELIAN ST STE 224
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1157
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Country | US
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Telephone | 909-688-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 N LILAC AVE
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City | RIALTO
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State | CA
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Zip | 92376-3274
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Country | US
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Telephone | 909-688-6604
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | SHAREELA ALLEN
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Credential |
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Telephone | 909-688-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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