Provider Demographics
NPI:1033612783
Name:VIDA COUNSELING SERVICES
Entity Type:Organization
Organization Name:VIDA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:951-220-8607
Mailing Address - Street 1:2900 ADAMS ST STE B30-16
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8311
Mailing Address - Country:US
Mailing Address - Phone:951-220-8607
Mailing Address - Fax:951-220-8607
Practice Address - Street 1:2900 ADAMS ST STE B30-16
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-8311
Practice Address - Country:US
Practice Address - Phone:951-220-8607
Practice Address - Fax:951-220-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty