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General NPI Number Information
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NPI Number | 1346047792
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Entity Type | Organization
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Legal Business Name | NATIVE SOUL WELLNESS
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 25581 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3125
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Country | US
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Telephone | 909-498-0208
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Fax |
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Provider Business Mailing Address
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Address Line | 25745 BARTON RD # 502
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City | LOMA LINDA
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State | CA
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Zip | 92354-3812
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Country | US
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Telephone | 909-498-0208
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Fax |
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Authorized Official
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Title or Position | OWNER AND CLINICAL DIRECTOR
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Name | ANTOINETTE M SCHRADER
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Credential | LPCC
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Telephone | 213-884-5291
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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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