Provider Demographics
NPI:1619165271
Name:HUMANISTIC COUNSELING CENTER
Entity Type:Organization
Organization Name:HUMANISTIC COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT INTERN
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:INTERN
Authorized Official - Phone:909-498-4929
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:951-488-9084
Mailing Address - Fax:951-485-8266
Practice Address - Street 1:12730 HEACOCK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3040
Practice Address - Country:US
Practice Address - Phone:951-488-9084
Practice Address - Fax:951-485-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health