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General NPI Number Information
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NPI Number | 1831831486
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Entity Type | Organization
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Legal Business Name | KINTSUGI FAMILY COUNSELING GROUP INC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 14420 CIVIC DR STE 6
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City | VICTORVILLE
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State | CA
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Zip | 92392-2384
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Country | US
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Telephone | 760-654-6894
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Fax | 760-227-5569
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Provider Business Mailing Address
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Address Line | PO BOX 2475
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City | CHINO HILLS
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State | CA
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Zip | 91709-0083
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Country | US
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Telephone | 760-654-6894
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Fax | 760-227-5569
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN BREWER
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Credential | LMFT
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Telephone | 760-654-6894
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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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