Provider Demographics
NPI:1639395858
Name:LIFE ARTS COUNSELING CENTER
Entity Type:Organization
Organization Name:LIFE ARTS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFCC
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMENKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:951-683-6322
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92502-1145
Mailing Address - Country:US
Mailing Address - Phone:951-683-6322
Mailing Address - Fax:951-683-6900
Practice Address - Street 1:4205 MARKET ST STE 2
Practice Address - Street 2:DOWNTOWN RIVERSIDE
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3515
Practice Address - Country:US
Practice Address - Phone:951-683-6322
Practice Address - Fax:951-683-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25858106H00000X, 251S00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty