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General NPI Number Information
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NPI Number | 1497491203
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Entity Type | Organization
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Legal Business Name | GRACE BRIDGE FAMILY COUNSELING SERVICES, PC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 39755 MURRIETA HOT SPRINGS RD STE D160
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City | MURRIETA
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State | CA
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Zip | 92563-9113
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Country | US
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Telephone | 951-294-5393
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Fax | 951-257-1071
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Provider Business Mailing Address
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Address Line | 39755 MURRIETA HOT SPRINGS RD STE D160
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City | MURRIETA
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State | CA
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Zip | 92563-9113
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Country | US
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Telephone | 951-294-5393
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Fax | 951-257-1071
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANIELLE LYNANN CISNEROS
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Credential | LMFT
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Telephone | 951-294-5393
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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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