Basic Information
| Provider Information | |||||||||
| NPI: | 1831494350 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NICHOLAS FITTANTE ACT FAMILY COUNSELING SERVICES LMFT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917626620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099835575 | ||||||||
| FaxNumber: | 9099831076 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917626620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099835575 | ||||||||
| FaxNumber: | 9099831076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | FITTANTE | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9099835575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP2701X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 106H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.