Provider Demographics
NPI:1326673914
Name:BLU ALLIANCE COUNSELING CENTER
Entity Type:Organization
Organization Name:BLU ALLIANCE COUNSELING CENTER
Other - Org Name:BLU ALLIANCE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-623-8093
Mailing Address - Street 1:1109 W SAN BERNARDINO RD STE 150
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4156
Mailing Address - Country:US
Mailing Address - Phone:626-623-8093
Mailing Address - Fax:
Practice Address - Street 1:1109 W SAN BERNARDINO RD STE 150
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4156
Practice Address - Country:US
Practice Address - Phone:626-623-8093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty