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General NPI Number Information
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NPI Number | 1770845497
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Entity Type | Organization
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Legal Business Name | YOUTHS' HOPE LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 255 N. D STREET, SUITE 400
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City | SAN BERNARDINO
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State | CA
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Zip | 92401
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Country | US
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Telephone | 909-567-2808
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Fax | 909-567-2808
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | PATTOM
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State | CA
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Zip | 92369-0264
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Country | US
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Telephone | 909-567-2808
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Fax | 909-567-2808
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Authorized Official
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Title or Position | CEO
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Name | DR. GEOFFREY BESTMAN IBEABUCHI
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Credential | PHD, LCSW
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Telephone | 909-567-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 18357
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License Number State | CA
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