NPIMap

Organization Active NPI

Canvas of Life Family Counseling Services Professional Corporation

  • Marriage & Family Therapist
  • Riverside, CA
National Provider Identifier
1992240279
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
77468 Issued in CA
Legal business name
CANVAS OF LIFE FAMILY COUNSELING SERVICES PROFESSIONAL CORPORATION
Practice address
6820 Indiana Ave
Ste. 240
Riverside, CA 92506-7202
Phone
(951) 777-8176
Fax
(951) 888-9049
NPI assigned
Dec 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Authorized official

Name
Lisa M Carrillo, LMFTNPI 1588965347
Title
Director
Phone
(951) 777-8176

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 77468 CA Primary

Addresses

Primary practice location

6820 Indiana Ave
Ste. 240
Riverside, CA 92506-7202

Mailing address

6820 Indiana Ave
Ste. 240
Riverside, CA 92506-7202
Phone (951) 777-8176

National Provider Directory

National Provider Directory

Locations

6820 Indiana Ave
Ste 240
Riverside, CA 92506
Phone (951) 777-8176

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": "1482364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1992240279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6820 INDIANA AVE",
            "address_2": "STE. 240",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925067202",
            "telephone_number": "951-777-8176",
            "fax_number": "951-888-9049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6820 INDIANA AVE",
            "address_2": "STE. 240",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925067202",
            "telephone_number": "951-777-8176",
            "fax_number": "951-888-9049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANVAS OF LIFE FAMILY COUNSELING SERVICES PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-22",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "951-777-8176",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "77468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.