Advocate Family Counseling Professional Corporation

Organization Active NPI Marriage & Family Therapist · Alta Loma, CA

NPI 1508601329 · NPPES record last updated Nov 21, 2024

Key facts

NPI
1508601329
Entity type
Organization (NPI type 2)
Primary specialty
Marriage & Family Therapist 106H00000X
Legal business name
ADVOCATE FAMILY COUNSELING PROFESSIONAL CORPORATION
Practice address
10578 Deer Canyon Dr
Alta Loma, CA 91737-2478
Phone
(909) 689-7241
NPI assigned
Jun 25, 2024
Organization subpart
No

Authorized official

Name
Sydney Simone Johnson, LMFT
Title
Therapist/Owner
Phone
(909) 689-7241

Practitioners 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250211003897 CA Part B Supplier - Clinic/Group Practice 2567996770 Receives reassigned benefits from 1 practitioner
Practice locations: Alta Loma, CA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist
Group: 193400000X SINGLE SPECIALTY GROUP
106H00000X Yes

Addresses

Primary practice location

10578 Deer Canyon Dr
Alta Loma, CA 91737-2478

Mailing address

8605 Santa Monica Blvd
West Hollywood, CA 90069-4109
Phone (909) 689-7241

Other providers in Alta Loma, CA

All providers in Alta Loma, CA · Marriage & Family Therapist in California

Sources for this page

Verify at the official NPI Registry.