NPIMap

Organization Active NPI

Blue Oak Counseling Services, Inc.

  • Marriage & Family Therapist
  • Ontario, CA
National Provider Identifier
1073124285
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
BLUE OAK COUNSELING SERVICES, INC.
Practice address
3200 E Guasti Rd Ste 100
Ontario, CA 91761-8661
Phone
(909) 306-8686
NPI assigned
Aug 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tina Tangtheinkul Avila, MA, LMFT
Title
Ceo
Phone
(909) 366-4712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

3200 E Guasti Rd Ste 100
Ontario, CA 91761-8661

Mailing address

3200 E Guasti Rd Ste 100
Ontario, CA 91761-8661
Phone (909) 306-8686

Other practice location 1

4193 Flat Rock Dr Ste 200-491
Riverside, CA 92505-7111
Phone (909) 366-4712

National Provider Directory

National Provider Directory
Tax ID family
Blue Oak Counseling Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4193 Flat Rock Dr
Ste 200491
Riverside, CA 92505
Phone (909) 366-4712

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1073124285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E GUASTI RD STE 100",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618661",
            "telephone_number": "909-306-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 E GUASTI RD STE 100",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618661",
            "telephone_number": "909-306-8686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4193 Flat Rock Dr Ste 200-491",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925057111",
            "country_code": "US",
            "telephone_number": "909-366-4712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE OAK COUNSELING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "TANGTHEINKUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-366-4712",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.