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General NPI Number Information
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NPI Number | 1679268668
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Entity Type | Organization
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Legal Business Name | SERENITY FAMILY THERAPY INC.
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 5015 CANYON CREST DR STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92507-6006
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Country | US
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Telephone | 909-649-3863
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Fax |
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Provider Business Mailing Address
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Address Line | 5015 CANYON CREST DR STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92507-6006
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Country | US
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Telephone | 909-649-3863
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GRISELDA ENGELAUF
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Credential | LMFT
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Telephone | 909-649-3863
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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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Taxonomy #2
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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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