Provider Demographics
NPI:1831831486
Name:KINTSUGI FAMILY COUNSELING GROUP INC
Entity type:Organization
Organization Name:KINTSUGI FAMILY COUNSELING GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-654-6894
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-0083
Mailing Address - Country:US
Mailing Address - Phone:760-654-6894
Mailing Address - Fax:760-227-5569
Practice Address - Street 1:14420 CIVIC DR STE 6
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2384
Practice Address - Country:US
Practice Address - Phone:760-654-6894
Practice Address - Fax:760-227-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)