Basic Information
| Provider Information | |||||||||
| NPI: | 1053861922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST END FAMILY COUNSELING SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 N EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917622729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099832020 | ||||||||
| FaxNumber: | 9099836847 | ||||||||
| Practice Location | |||||||||
| Address1: | 9445 FAIRWAY VIEW PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917300930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099832020 | ||||||||
| FaxNumber: | 9099836847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAPIA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9099832020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1942323563 | 05 | CA | MEDICAID |