Provider Demographics
NPI:1760110530
Name:PARRA COUNSELING AND WELLNESS SERVICES, A LICENSED CLINICAL SOCIAL WOR
Entity Type:Organization
Organization Name:PARRA COUNSELING AND WELLNESS SERVICES, A LICENSED CLINICAL SOCIAL WOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-318-7798
Mailing Address - Street 1:3160 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3724
Mailing Address - Country:US
Mailing Address - Phone:512-673-5229
Mailing Address - Fax:951-468-3087
Practice Address - Street 1:3160 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3724
Practice Address - Country:US
Practice Address - Phone:951-267-3522
Practice Address - Fax:951-468-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA232096Medicaid