=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922458140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HORIZONS BILINGUAL COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2016
-----------------------------------------------------
Last Update Date | 06/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 W COLTON AVE STE 585
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-568-8797
-----------------------------------------------------
Fax | 909-575-3664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 W COLTON AVE STE 585
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-568-8797
-----------------------------------------------------
Fax | 909-575-3664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIROSLAVA VILLEGAS REYES
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 909-568-8797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MFC91001
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------