Provider Demographics
NPI:1497131569
Name:CENTRO ILUMINA FAMILY COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:CENTRO ILUMINA FAMILY COUNSELING SERVICES, INC
Other - Org Name:CENTRO ILUMINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTKEWICH DE BEHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-414-5164
Mailing Address - Street 1:3435 CAMINO DEL RIO S STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3911
Mailing Address - Country:US
Mailing Address - Phone:619-494-0990
Mailing Address - Fax:
Practice Address - Street 1:3435 CAMINO DEL RIO S STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3911
Practice Address - Country:US
Practice Address - Phone:619-494-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT77672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty