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General NPI Number Information
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NPI Number | 1760356794
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Entity Type | Organization
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Legal Business Name | LIFE TRANSFORMER
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 7365 CARNELIAN ST STE 232
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1136
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Country | US
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Telephone | 626-423-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 12672 LIMONITE AVE STE 3E
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City | EASTVALE
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State | CA
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Zip | 92880-4208
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Country | US
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Telephone | 626-423-9193
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPHINE CHU
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Credential | LMFT
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Telephone | 626-423-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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