Mainline Family Counseling Service Prof Corp | |
14726 Ramona Ave # E10 Chino CA 91710-5730 | |
(909) 334-2824 | |
Not Available |
Full Name | Mainline Family Counseling Service Prof Corp |
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Speciality | Community/Behavioral Health |
Location | 14726 Ramona Ave # E10, Chino, California |
Authorized Official Name and Position | Peter Lo (OWNER) |
Authorized Official Contact | 9093342824 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mainline Family Counseling Service Prof Corp 14726 Ramona Ave # E10 Chino CA 91710-5730 Ph: () - | Mainline Family Counseling Service Prof Corp 14726 Ramona Ave # E10 Chino CA 91710-5730 Ph: (909) 334-2824 |
NPI Number | 1124697164 |
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Provider Enumeration Date | 06/23/2021 |
Last Update Date | 03/04/2024 |
Certification Date | 03/04/2024 |
Medicare PECOS PAC ID | 9032555263 |
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Medicare Enrollment ID | O20240311002657 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124697164 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Peter Shin Lo |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1285047282 PECOS PAC ID: 0941646178 Enrollment ID: I20240314000394 |
Provider Name | Jasmine Roberts |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1164292744 PECOS PAC ID: 7416396478 Enrollment ID: I20240423004611 |
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