MEDICARE: INLAND EMPIRE MULTI-CULTURAL COUNSELING

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	1041C0700X	Clinical Social Worker	LCSW16424	CA

General Provider Information

NPI Number	:	1770977308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND EMPIRE MULTI-CULTURAL COUNSELING

Provider Business Mailing Address
First Line	:	6809 INDIANA AVE # 154
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4221
Country	:	US
Telephone Number	:	951-202-2134
Fax Number	:	951-231-1595

Provider Business Practice Location Address
First Line	:	6809 INDIANA AVE # 154
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4221
Country	:	US
Telephone Number	:	951-202-2134
Fax Number	:	951-231-1595

Authorized Official
Title or Position	:	OWNER
Name	:	JEWEL THOMPSON
Credential	:	LCSW
Telephone Number	:	951-202-2134

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	04/14/2015

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