NPIMap

Organization Active NPI

Church Counseling Service Inc

  • Marriage & Family Therapist
  • Upland, CA
National Provider Identifier
1265711642
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MF013902 Issued in CA
Legal business name
CHURCH COUNSELING SERVICE INC
Practice address
188 W Langston St
Upland, CA 91786-3123
Phone
(909) 982-8687
NPI assigned
Aug 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

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

Authorized official

Name
Richard Fort, MA MFTNPI 1518039437
Title
President
Phone
(909) 982-8687

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X MF013902 CA Primary

Addresses

Primary practice location

188 W Langston St
Upland, CA 91786-3123

Mailing address

188 W Langston St
Upland, CA 91786-3123
Phone (909) 982-8687

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1265711642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 W LANGSTON ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863123",
            "telephone_number": "909-982-8687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 W LANGSTON ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863123",
            "telephone_number": "909-982-8687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH COUNSELING SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-08-16",
        "status": "A",
        "authorized_official_last_name": "FORT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-982-8687",
        "authorized_official_credential": "MA MFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MF013902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; 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.