Organization
EDGE THERAPY AND LIFE COACHING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE BAUTISTA LCSW (DIRECTOR)
(909) 202-8361
Entity
Organization
Contact information
Practice address
6101 CHERRY AVE STE 205, FONTANA, CA 92336-5362
(909) 202-8361
Mailing address
6101 CHERRY AVE STE 205, FONTANA, CA 92336-5362
(909) 202-8361
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033800560
NPI TYPE 1
CA
Enumeration date
05/16/2025
Last updated
05/16/2025
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