Provider Demographics
NPI:1497491203
Name:GRACE BRIDGE FAMILY COUNSELING SERVICES, PC
Entity type:Organization
Organization Name:GRACE BRIDGE FAMILY COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LYNANN
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-294-5393
Mailing Address - Street 1:39755 MURRIETA HOT SPRINGS RD STE D160
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-9113
Mailing Address - Country:US
Mailing Address - Phone:951-294-5393
Mailing Address - Fax:951-257-1071
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD STE D160
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9113
Practice Address - Country:US
Practice Address - Phone:951-294-5393
Practice Address - Fax:951-257-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty