Provider Demographics
NPI:1386419521
Name:HEAD & HEART FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:HEAD & HEART FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY-SURINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-255-6554
Mailing Address - Street 1:625 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4422
Mailing Address - Country:US
Mailing Address - Phone:909-255-6554
Mailing Address - Fax:
Practice Address - Street 1:790 INDIGO CT STE C
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2272
Practice Address - Country:US
Practice Address - Phone:909-255-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health