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General NPI Number Information
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NPI Number | 1679916787
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 229 S RIVERSIDE AVE SUITE M
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City | RIALTO
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State | CA
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Zip | 92376-6467
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Country | US
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Telephone | 909-873-8363
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Fax | 909-873-5039
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Provider Business Mailing Address
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Address Line | PO BOX 2918
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315-2918
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Country | US
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Telephone | 909-873-8363
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Fax | 909-873-5039
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ANNETTE ALLEN JENKINS
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Credential | LMFT
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Telephone | 909-873-8363
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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 | MFC28241
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License Number State | CA
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