=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528433422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FELICIA HUNT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2015
-----------------------------------------------------
Last Update Date | 12/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11777 SEBASTIAN WAY STE 120A-B
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-0707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-989-9724
-----------------------------------------------------
Fax | 909-989-0249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11777 SEBASTIAN WAY STE 120A-B
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-0707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-989-9724
-----------------------------------------------------
Fax | 909-989-0249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 76461
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------