Provider Demographics
NPI:1083196166
Name:LOBBAN MARRIAGE AND FAMILY THERAPY INC
Entity Type:Organization
Organization Name:LOBBAN MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:RESTORATIONS COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-LOBBAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-300-5446
Mailing Address - Street 1:PO BOX 7705
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-7705
Mailing Address - Country:US
Mailing Address - Phone:909-255-6500
Mailing Address - Fax:
Practice Address - Street 1:473 E. CARNEGIE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-255-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty