=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356216881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNDER THIS UMBRELLA COMMUNITY FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2025
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16843 VALLEY BLVD STE E
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-6666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-201-8266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 HARVARD AVE # 386
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91711-4716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-201-8266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | PATRICIA L SELLERS
-----------------------------------------------------
Credential | AMFT
-----------------------------------------------------
Telephone | 626-201-8266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------