Provider Demographics
NPI:1003577453
Name:CITRUS CITY FAMILY COUNSELING
Entity Type:Organization
Organization Name:CITRUS CITY FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CUDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-203-8737
Mailing Address - Street 1:1793 WREN AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2939
Mailing Address - Country:US
Mailing Address - Phone:951-203-8737
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE STE 130
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4266
Practice Address - Country:US
Practice Address - Phone:951-203-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty