Provider Demographics
NPI:1891383188
Name:TERRA VISTA COUNSELING
Entity Type:Organization
Organization Name:TERRA VISTA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-454-3074
Mailing Address - Street 1:10601 CHURCH ST STE 124
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6840
Mailing Address - Country:US
Mailing Address - Phone:909-452-5857
Mailing Address - Fax:
Practice Address - Street 1:10601 CHURCH ST STE 124
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6840
Practice Address - Country:US
Practice Address - Phone:909-452-5857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health