Provider Demographics
NPI:1124691365
Name:ICLASS TREATMENT CENTER INC.
Entity type:Organization
Organization Name:ICLASS TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENALDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-351-6937
Mailing Address - Street 1:3380 LASIERRA AVENUE
Mailing Address - Street 2:SUITE 104-730
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6754
Mailing Address - Country:US
Mailing Address - Phone:909-343-3135
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 180
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:818-351-6937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty