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General NPI Number Information
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NPI Number | 1982096566
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Entity Type | Organization
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Legal Business Name | MINDFUL SOLUTIONS MENTAL HEALTH & SUPPORT SERVICES
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 7365 CAMELIAN STREET SUITE 217-D
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 909-831-4891
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Fax | 909-945-5555
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Provider Business Mailing Address
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Address Line | 8272 MALACHITE AVENUE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 909-831-4891
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Fax | 909-945-5555
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Authorized Official
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Title or Position | OWNER
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Name | MISS LORENA LEMUS YBANEZ
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Credential | LCSW
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Telephone | 909-831-4891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS-29744
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License Number State | CA
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