Therapy Mission Licensed Clinical Social Worker PC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THERAPY MISSION LICENSED CLINICAL SOCIAL WORKER PC

Practice address

554 E Foothill Blvd Ste 106
San Dimas, CA 91773-1222

Phone

(626) 714-0011

NPI assigned

Jan 19, 2022

Organization subpart

No

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

Authorized official

Name

Reina Avila, LCSWNPI 1992211833

Title

Ceo

Phone

(626) 714-0011

Specialties & licenses 1

Addresses

Other names 1

• Therapy Mission Doing business as

Locations

Practitioners 1

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

• Reina Avila

  • Social Worker
  • Claremont, CA
  • NPI 1992211833
  NPD Authorized official

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1346992500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 E FOOTHILL BLVD STE 106",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731222",
            "telephone_number": "626-714-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 E FOOTHILL BLVD STE 106",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731222",
            "telephone_number": "626-714-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPY MISSION LICENSED CLINICAL SOCIAL WORKER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "REINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-714-0011",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Therapy Mission",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lillie Lashawn Theus
• Thomas E Smith DPM
• Rebecca J. Tkach, HHP,CST,LMT
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• Brenda Tolentino

• Mental Health Clinic/Center (Including Community Mental Health Center) in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.