Provider Demographics
NPI:1205955408
Name:ADVANCED COUNSELING & PSYCHIATRIC OFFICES
Entity type:Organization
Organization Name:ADVANCED COUNSELING & PSYCHIATRIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-947-0070
Mailing Address - Street 1:16279 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3622
Mailing Address - Country:US
Mailing Address - Phone:760-947-0070
Mailing Address - Fax:760-947-3494
Practice Address - Street 1:16279 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3622
Practice Address - Country:US
Practice Address - Phone:760-947-0070
Practice Address - Fax:760-947-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty