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General NPI Number Information
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NPI Number | 1750775714
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Entity Type | Organization
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Legal Business Name | COMMUNITY CENTER FOR HEALTHY MINDS (CCHM)
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 13800 HEACOCK ST STE D139B
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City | MORENO VALLEY
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State | CA
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Zip | 92553-6276
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Country | US
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Telephone | 951-656-6969
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Fax | 951-656-6868
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Provider Business Mailing Address
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Address Line | 13800 HEACOCK ST STE D139B
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City | MORENO VALLEY
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State | CA
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Zip | 92553-6276
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Country | US
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Telephone | 951-656-6969
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Fax | 951-656-6868
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK FLOURNOY
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Credential | LMFT
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Telephone | 951-656-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MFC20033
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License Number State | CA
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