Provider Demographics
NPI:1699301978
Name:HEALING LOGOS CHRISTIAN FAMILY COUNSELING, INC.
Entity type:Organization
Organization Name:HEALING LOGOS CHRISTIAN FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:909-726-5042
Mailing Address - Street 1:9567 ARROW RTE STE P
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4550
Mailing Address - Country:US
Mailing Address - Phone:909-726-5042
Mailing Address - Fax:909-752-5433
Practice Address - Street 1:9567 ARROW RTE STE P
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4550
Practice Address - Country:US
Practice Address - Phone:909-726-5042
Practice Address - Fax:909-752-5433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALING LOGOS CHRISTIAN COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215430723Medicaid