Provider Demographics
NPI:1063639623
Name:CHINO MENTAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:CHINO MENTAL HEALTH ASSOCIATES
Other - Org Name:CHINO MENTAL HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-591-4033
Mailing Address - Street 1:13751 ROSWELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5464
Mailing Address - Country:US
Mailing Address - Phone:909-591-4033
Mailing Address - Fax:909-902-6055
Practice Address - Street 1:13751 ROSWELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5464
Practice Address - Country:US
Practice Address - Phone:909-591-4033
Practice Address - Fax:909-902-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty