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General NPI Number Information
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NPI Number | 1760195838
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Entity Type | Organization
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Legal Business Name | LA VID TREE OF LIFE MARRIAGE AND FAMILY THERAPY SERVICES INC.
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 8273 WHITE OAK AVE # B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7671
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Country | US
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Telephone | 840-207-9256
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Fax |
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Provider Business Mailing Address
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Address Line | 523 W ELM ST
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City | ONTARIO
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State | CA
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Zip | 91762-5712
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Country | US
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Telephone | 909-631-5768
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARLYN XIOMARA MENDOZA
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Credential | LMFT
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Telephone | 909-631-5768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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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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