Basic Information
| Provider Information | |||||||||
| NPI: | 1003272279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATLAS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | K. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12968 FREDERICK ST | ||||||||
| Address2: | STE. A | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512080150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12968 FREDERICK ST | ||||||||
| Address2: | STE. A | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512080150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2016 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF7350 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.