Provider Demographics
NPI:1043978570
Name:TRINITY THRIVE MARRIAGE AND FAMILY THERAPY CENTER, INC
Entity Type:Organization
Organization Name:TRINITY THRIVE MARRIAGE AND FAMILY THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-579-7420
Mailing Address - Street 1:358 E BONITA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3172
Mailing Address - Country:US
Mailing Address - Phone:909-413-4814
Mailing Address - Fax:
Practice Address - Street 1:358 E BONITA AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3172
Practice Address - Country:US
Practice Address - Phone:909-413-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty