Provider Demographics
NPI:1235439332
Name:RANCHO FAMILY COUNSELING, INC.
Entity Type:Organization
Organization Name:RANCHO FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:TACQUARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-764-0537
Mailing Address - Street 1:28999 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5805
Mailing Address - Country:US
Mailing Address - Phone:951-764-0537
Mailing Address - Fax:
Practice Address - Street 1:28999 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5805
Practice Address - Country:US
Practice Address - Phone:951-764-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154471530OtherINDIVIDUAL NPI AS LMFT
CAMFC 38834OtherLICENSED MARRIAGE FAMILY THERAPIST