| Kintsugi Family Counseling Group Inc | |
|
14420 Civic Dr Ste 6 Victorville CA 92392-2384 | |
| (760) 654-6894 | |
| (760) 227-5569 |
| Full Name | Kintsugi Family Counseling Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14420 Civic Dr Ste 6, Victorville, California |
| Authorized Official Name and Position | Steven Brewer (OWNER) |
| Authorized Official Contact | 7606546894 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintsugi Family Counseling Group Inc Po Box 2475 Chino Hills CA 91709-0083 Ph: (760) 654-6894 | Kintsugi Family Counseling Group Inc 14420 Civic Dr Ste 6 Victorville CA 92392-2384 Ph: (760) 654-6894 |
| NPI Number | 1831831486 |
|---|---|
| Provider Enumeration Date | 04/12/2022 |
| Last Update Date | 04/12/2022 |
| Certification Date | 04/12/2022 |
| Medicare PECOS PAC ID | 8426581737 |
|---|---|
| Medicare Enrollment ID | O20241024004148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831831486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Steven Douglas Brewer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619364676 PECOS PAC ID: 9335672641 Enrollment ID: I20241024004181 |
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