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General NPI Number Information
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NPI Number | 1962257774
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Entity Type | Organization
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Legal Business Name | INSITE SERVICES: PROFESSIONAL CLINICAL COUNSELORS, INC.
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 1254 S WATERMAN AVE STE 44
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2858
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Country | US
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Telephone | 909-385-3185
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 S WATERMAN AVE STE 44
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2858
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Country | US
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Telephone | 909-385-3185
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WANDALYN LANE
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Credential | LMFT
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Telephone | 909-385-3185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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