Provider Demographics
NPI:1902418163
Name:BLUE OAK COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:BLUE OAK COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:TANGTHEINKUL
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-306-8686
Mailing Address - Street 1:3200 GUASTI RD #100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761
Mailing Address - Country:US
Mailing Address - Phone:909-306-8686
Mailing Address - Fax:909-510-8260
Practice Address - Street 1:3200 GUASTI RD #100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-306-8686
Practice Address - Fax:909-510-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty