| B.o.l.d.l.y. Therapy A Marriage And Family Therapy Professional Corpor | |
|
3200 E Guasti Rd Ste 100 Ontario CA 91761-8661 | |
| (323) 639-0558 | |
| Not Available |
| Full Name | B.o.l.d.l.y. Therapy A Marriage And Family Therapy Professional Corpor |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3200 E Guasti Rd Ste 100, Ontario, California |
| Authorized Official Name and Position | Brandi Nycole Walker (PRESIDENT) |
| Authorized Official Contact | 3236390558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| B.o.l.d.l.y. Therapy A Marriage And Family Therapy Professional Corpor 3200 E Guasti Rd Ste 100 Ontario CA 91761-8661 Ph: () - | B.o.l.d.l.y. Therapy A Marriage And Family Therapy Professional Corpor 3200 E Guasti Rd Ste 100 Ontario CA 91761-8661 Ph: (323) 639-0558 |
| NPI Number | 1932794245 |
|---|---|
| Provider Enumeration Date | 03/08/2021 |
| Last Update Date | 03/08/2021 |
| Certification Date | 03/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932794245 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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