=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700670460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUELED BY EMPOWERMENT MARRIAGE THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2888 E BERRY LOOP PRIVADO UNIT 44
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91761-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-651-5169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2933
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92516-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-651-5169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHRISTOPHER RIOS BERRIOS
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 714-651-5169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------