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General NPI Number Information
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NPI Number | 1972435196
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Entity Type | Organization
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Legal Business Name | TWELVE TWO INC.
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 207 N EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3535
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Country | US
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Telephone | 909-477-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 13230 WINSLOW DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9271
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Country | US
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Telephone | 909-477-1910
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ATHENA OBRIEN
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Credential |
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Telephone | 909-477-1910
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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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