Provider Demographics
NPI:1821326158
Name:BOUNDARIES FAMILY COUNSELING &LICENSED CLINICAL SOCIAL WORKER CORP.
Entity Type:Organization
Organization Name:BOUNDARIES FAMILY COUNSELING &LICENSED CLINICAL SOCIAL WORKER CORP.
Other - Org Name:BOUNDARIES CLINIC, BOUNDARIES FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS GINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-212-4454
Mailing Address - Street 1:105 N ROSE ST
Mailing Address - Street 2:STE. 211
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-7222
Mailing Address - Country:US
Mailing Address - Phone:760-705-8468
Mailing Address - Fax:760-735-2922
Practice Address - Street 1:135 E 3RD AVE
Practice Address - Street 2:STE. B
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4252
Practice Address - Country:US
Practice Address - Phone:760-705-8468
Practice Address - Fax:760-735-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20560251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health