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General NPI Number Information
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NPI Number | 1760154330
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Entity Type | Organization
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Legal Business Name | BEAUREGARD FAMILY THERAPY GROUP PROF. CORP
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 1325 E COOLEY DR STE 106
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City | COLTON
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State | CA
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Zip | 92324-3966
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Country | US
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Telephone | 909-855-0348
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Fax | 909-752-6182
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Provider Business Mailing Address
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Address Line | 1325 E COOLEY DR STE 106
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City | COLTON
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State | CA
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Zip | 92324-3966
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Country | US
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Telephone | 909-855-0348
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Fax | 909-752-6182
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN G BEAUREGARD
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Credential |
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Telephone | 909-492-0573
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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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