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Organization
OUTREACH NATION, CORP
Active
Organization
OUTREACH NATION, CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KHALIDA KHANUM (PROGRAM DIRECTOR)
(909) 825-8080
Entity
Organization
Contact information
Practice address
9565 BUSINESS CENTER DR STE A, RANCHO CUCAMONGA, CA 91730-4560
(909) 825-8080
Mailing address
9565 BUSINESS CENTER DR BLDG 11 SUITE A, RANCHO CUCAMONGA, CA 91730
(909) 825-8080
(909) 292-4532
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW28947
CA
106H00000X
Marriage & Family Therapist
LCSW28841
CA
106H00000X
Marriage & Family Therapist
MFTI60442
CA
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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