MEDICARE: G.R.I.T.S. COLLECTIVE A MARRIAGE AND FAMILY THERAPY CORPORATION

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1720814064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G.R.I.T.S. COLLECTIVE A MARRIAGE AND FAMILY THERAPY CORPORATION

Provider Business Mailing Address
First Line	:	39525 LOS ALAMOS RD STE C452
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-5082
Country	:	US
Telephone Number	:	951-417-4813
Fax Number	:	951-260-2786

Provider Business Practice Location Address
First Line	:	39525 LOS ALAMOS RD STE C452
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-5082
Country	:	US
Telephone Number	:	951-417-4813
Fax Number	:	951-260-2786

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CIERRA GUERRA
Credential	:	LMFT
Telephone Number	:	951-417-4813

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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