Provider Demographics
NPI:1902428089
Name:CHE AJAL FAMILY COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:CHE AJAL FAMILY COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:GENOVEVA
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 106356
Authorized Official - Phone:916-600-6145
Mailing Address - Street 1:PO BOX 6338
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91909-6338
Mailing Address - Country:US
Mailing Address - Phone:916-600-6145
Mailing Address - Fax:
Practice Address - Street 1:250 W OCEAN BLVD APT 1201
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7940
Practice Address - Country:US
Practice Address - Phone:916-600-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)