Provider Demographics
NPI:1891273918
Name:CORAZON COUNSELING SERVICE
Entity Type:Organization
Organization Name:CORAZON COUNSELING SERVICE
Other - Org Name:CORAZON COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:ORTEGA
Authorized Official - Last Name:JARA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-452-0067
Mailing Address - Street 1:3742 TIBBETTS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2641
Mailing Address - Country:US
Mailing Address - Phone:951-452-0067
Mailing Address - Fax:
Practice Address - Street 1:3742 TIBBETTS ST STE 201
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2641
Practice Address - Country:US
Practice Address - Phone:951-452-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty