Provider Demographics
NPI:1891466520
Name:SELF DISCOVERY CENTER
Entity Type:Organization
Organization Name:SELF DISCOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-830-5898
Mailing Address - Street 1:13285 CARDINAL RIDGE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1234
Mailing Address - Country:US
Mailing Address - Phone:909-782-5460
Mailing Address - Fax:
Practice Address - Street 1:13285 CARDINAL RIDGE RD UNIT B
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1234
Practice Address - Country:US
Practice Address - Phone:909-782-5460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty