Provider Demographics
NPI:1174913321
Name:SERENE PATHWAYS FAMILY COUNSELING INC
Entity type:Organization
Organization Name:SERENE PATHWAYS FAMILY COUNSELING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-591-5085
Mailing Address - Street 1:11800 CENTRAL AVE, SUITE 225
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-576-3889
Mailing Address - Fax:909-591-5094
Practice Address - Street 1:11800 CENTRAL AVE STE 225
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7201
Practice Address - Country:US
Practice Address - Phone:909-591-5085
Practice Address - Fax:909-591-5094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENE PATHWAYS FAMILY COUNSELING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-27
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992845218OtherINDIVIDUAL NPI