Provider Demographics
NPI:1760154330
Name:BEAUREGARD FAMILY THERAPY GROUP
Entity Type:Organization
Organization Name:BEAUREGARD FAMILY THERAPY GROUP
Other - Org Name:JONATHAN G. BEAUREGARD LMFT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-855-0348
Mailing Address - Street 1:1325 E COOLEY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3966
Mailing Address - Country:US
Mailing Address - Phone:909-855-0348
Mailing Address - Fax:909-752-6182
Practice Address - Street 1:1325 E COOLEY DR STE 106
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3966
Practice Address - Country:US
Practice Address - Phone:909-855-0348
Practice Address - Fax:909-752-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty