Provider Demographics
NPI:1538825914
Name:JILL R DIAMOND DE PORRAS LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Entity type:Organization
Organization Name:JILL R DIAMOND DE PORRAS LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND DE PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-288-6835
Mailing Address - Street 1:27715 JEFFERSON AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-6601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27715 JEFFERSON AVE STE 112
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-6601
Practice Address - Country:US
Practice Address - Phone:951-288-6835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)