Provider Demographics
NPI:1346392040
Name:HUMANISTIC FFA, INC.
Entity Type:Organization
Organization Name:HUMANISTIC FFA, INC.
Other - Org Name:HUMANISTIC COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:951-488-1355
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1167
Mailing Address - Country:US
Mailing Address - Phone:951-485-7793
Mailing Address - Fax:909-494-4151
Practice Address - Street 1:13800 HEACOCK ST STE D117
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3340
Practice Address - Country:US
Practice Address - Phone:951-488-9084
Practice Address - Fax:951-488-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization