Provider Demographics
NPI:1225831670
Name:GUIDED LIFE THERAPEUTICS
Entity type:Organization
Organization Name:GUIDED LIFE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:BOULWARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-506-6265
Mailing Address - Street 1:600 N EUCLID AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4779
Mailing Address - Country:US
Mailing Address - Phone:747-218-1622
Mailing Address - Fax:
Practice Address - Street 1:600 N EUCLID AVE STE 103
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4779
Practice Address - Country:US
Practice Address - Phone:747-218-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)