Provider Demographics
NPI:1679916787
Name:HEALING HEARTS COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:HEALING HEARTS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-873-8363
Mailing Address - Street 1:PO BOX 2918
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-2918
Mailing Address - Country:US
Mailing Address - Phone:909-873-8363
Mailing Address - Fax:909-873-5039
Practice Address - Street 1:229 S RIVERSIDE AVE
Practice Address - Street 2:SUITE M
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6467
Practice Address - Country:US
Practice Address - Phone:909-873-8363
Practice Address - Fax:909-873-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty