A New Creation Child, Individual & Family Counseling Treatment Center

Primary specialty

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

License

LMFT 49399 Issued in CA

Legal business name

A NEW CREATION CHILD, INDIVIDUAL & FAMILY COUNSELING TREATMENT CENTER

Practice address

23800 Sunnymead Blvd Ste D
Moreno Valley, CA 92553-7731

Phone

(310) 420-5341

Fax

(888) 313-0140

NPI assigned

Nov 22, 2015

Last updated

Mar 25, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paulette Douglas, LMFTNPI 1265610273

Title

President & Ceo

Phone

(310) 963-7174

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paulette Douglas, MFT

  • Marriage & Family Therapist
  • Moreno Valley, CA
  • NPI 1265610273
  NPD (past) Authorized official

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

{
    "created_epoch": "1448150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553472000000",
    "number": "1992179360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23800 SUNNYMEAD BLVD STE D",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537731",
            "telephone_number": "310-963-7174",
            "fax_number": "888-313-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23800 SUNNYMEAD BLVD STE D",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537731",
            "telephone_number": "310-420-5341",
            "fax_number": "888-313-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A NEW CREATION CHILD, INDIVIDUAL & FAMILY COUNSELING TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-22",
        "last_updated": "2019-03-25",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "310-963-7174",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "LMFT 49399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Moreno Valley, CA
• Providers in Moreno Valley, 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 Mar 25, 2019; 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.