MEDICARE: VISTA GUIDANCE CENTERS, IN.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	360023DN	CA
2	251S00000X	Community/Behavioral Health Agency		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124158498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA GUIDANCE CENTERS, IN.C

Provider Business Mailing Address
First Line	:	PO BOX 7369
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92375-0369
Country	:	US
Telephone Number	:	909-335-7067
Fax Number	:	909-792-2045

Provider Business Practice Location Address
First Line	:	939 N D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92418-0001
Country	:	US
Telephone Number	:	909-381-5100
Fax Number	:	909-381-5101

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MRS. SONIA JENNY BORJA
Credential	:
Telephone Number	:	909-335-7067

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	09/11/2025

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