=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871012203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HEARTS MARRIAGE AND FAMILY THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2017
-----------------------------------------------------
Last Update Date | 09/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3610 CENTRAL AVE STE 400
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92506-5907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-285-0510
-----------------------------------------------------
Fax | 951-552-1647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3870 LA SIERRA AVE # 192
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92505-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-285-0510
-----------------------------------------------------
Fax | 951-552-1647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. TERESA ALVARADO
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 951-285-0510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | LMFT86368
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------