Basic Information
| Provider Information | |||||||||
| NPI: | 1093020836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMLA | ||||||||
| FirstName: | ART | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8363 FALL CREEK DR | ||||||||
| Address2: | |||||||||
| City: | EASTVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928803914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183592425 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 W HOSPITALITY LN STE 208 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099635377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 62994 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.