Provider Demographics
NPI:1164972048
Name:ALBERS FAMILY COUNSELING
Entity Type:Organization
Organization Name:ALBERS FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D,
Authorized Official - Phone:909-730-6400
Mailing Address - Street 1:21660 COPLEY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4173
Mailing Address - Country:US
Mailing Address - Phone:909-396-6888
Mailing Address - Fax:909-396-6889
Practice Address - Street 1:21660 COPLEY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4173
Practice Address - Country:US
Practice Address - Phone:909-396-6888
Practice Address - Fax:909-396-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11353Medicare UPIN