Organization
COUNTY OF SAN BERNARDINO
Active
Other names
DAAS AGE WISE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK EDWARD THOMAS LMFT (MENTAL HEALTH CLINIC SUPERVISOR)
(951) 662-3730
Entity
Organization
Contact information
Practice address
18818 HWY 18, APPLE VALLEY, CA 92307-0009
(760) 995-8813
(760) 995-8929
Mailing address
18818 HWY 18, APPLE VALLEY, CA 92307-0009
(760) 995-8813
(760) 995-8929
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
ZZZ74743Z
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36DM
—
CA
Enumeration date
05/09/2007
Last updated
04/18/2023
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