=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699492116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I & C FAMILY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2022
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25460 MEDICAL CENTER DR STE 203
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-5985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-483-8169
-----------------------------------------------------
Fax | 951-263-4577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25460 MEDICAL CENTER DR STE 203
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-5985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-483-8169
-----------------------------------------------------
Fax | 951-263-4577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. IRMA CABRAL
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 619-869-2539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------