Provider Demographics
NPI:1619712726
Name:WELLNESS RANCH EQUINE ASSISTED THERAPY
Entity type:Organization
Organization Name:WELLNESS RANCH EQUINE ASSISTED THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:909-710-3055
Mailing Address - Street 1:9721 BRILLIANT LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2920
Mailing Address - Country:US
Mailing Address - Phone:909-710-3055
Mailing Address - Fax:
Practice Address - Street 1:9721 BRILLIANT LN
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-2920
Practice Address - Country:US
Practice Address - Phone:909-710-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health