Provider Demographics
NPI:1669603775
Name:GATEWAY COUNSELING CENTER, INC
Entity type:Organization
Organization Name:GATEWAY COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:951-768-1535
Mailing Address - Street 1:3576 ARLINGTON AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3988
Mailing Address - Country:US
Mailing Address - Phone:951-768-1535
Mailing Address - Fax:866-896-6067
Practice Address - Street 1:245 N MURRAY ST STE A
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5528
Practice Address - Country:US
Practice Address - Phone:951-768-1535
Practice Address - Fax:866-896-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health