Basic Information
| Provider Information | |||||||||
| NPI: | 1710367289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCUS | ||||||||
| FirstName: | ALLISON | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3930 OBSIDIAN RD | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924070402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096770712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 INLAND EMPIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262545000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2015 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF96616 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 127347 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.