Provider Demographics
NPI:1093020836
Name:IMLA, ART (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ART
Middle Name:
Last Name:IMLA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 FALL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3914
Mailing Address - Country:US
Mailing Address - Phone:818-359-2425
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN STE 208
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3211
Practice Address - Country:US
Practice Address - Phone:909-963-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist