Provider Demographics
NPI:1568895852
Name:ACRO COUNSELING CENTER
Entity Type:Organization
Organization Name:ACRO COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENTIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-284-4202
Mailing Address - Street 1:3333 S BREA CANYON RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3786
Mailing Address - Country:US
Mailing Address - Phone:909-274-7757
Mailing Address - Fax:909-274-7754
Practice Address - Street 1:3333 S BREA CANYON RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3786
Practice Address - Country:US
Practice Address - Phone:909-274-7757
Practice Address - Fax:909-274-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY092761Medicaid
CAPSY092761Medicaid