Provider Demographics
NPI:1710696851
Name:NOVA INDIVIDUAL AND FAMILY THERAPY INC
Entity Type:Organization
Organization Name:NOVA INDIVIDUAL AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-281-3364
Mailing Address - Street 1:9431 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5878
Mailing Address - Country:US
Mailing Address - Phone:760-281-3364
Mailing Address - Fax:
Practice Address - Street 1:9431 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5878
Practice Address - Country:US
Practice Address - Phone:760-281-3364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty