Provider Demographics
NPI:1346917598
Name:ESPINOZA, CARLOS HUMBERTO JR (MS, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:ESPINOZA
Suffix:JR
Gender:M
Credentials:MS, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 BARTON RD # 426
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1410
Mailing Address - Country:US
Mailing Address - Phone:909-677-1314
Mailing Address - Fax:
Practice Address - Street 1:1908 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3436
Practice Address - Country:US
Practice Address - Phone:909-890-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA125755OtherASSOCIATE MARRIAGE AND FAMILY THERAPIST
CA9625OtherASSOCIATE PROFESSIONAL CLINICAL COUNSELOR