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14201 Kentwood Blvd Ste 2 Victorville CA 92392-2472 | |
| (442) 348-3822 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 14201 Kentwood Blvd Ste 2, Victorville, California |
| Authorized Official Name and Position | Anthonie O Etienne (CEO/LMFT) |
| Authorized Official Contact | 7608815559 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 731915 Puyallup WA 98373-0045 Ph: (760) 881-5559 | 14201 Kentwood Blvd Ste 2 Victorville CA 92392-2472 Ph: (442) 348-3822 |
| NPI Number | 1225730435 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225730435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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