Provider Demographics
NPI:1841981370
Name:MY THERAPY TRIBE LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:MY THERAPY TRIBE LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-289-4390
Mailing Address - Street 1:605 W. H. ST.
Mailing Address - Street 2:STE. 103
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227
Mailing Address - Country:US
Mailing Address - Phone:909-289-4390
Mailing Address - Fax:208-285-4605
Practice Address - Street 1:605 W. H. ST.
Practice Address - Street 2:STE. 103
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227
Practice Address - Country:US
Practice Address - Phone:909-289-4390
Practice Address - Fax:208-285-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty