Provider Demographics
NPI:1548866080
Name:SERENITY CHRISTIAN THERAPY
Entity type:Organization
Organization Name:SERENITY CHRISTIAN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-385-7041
Mailing Address - Street 1:147 W ROUTE 66
Mailing Address - Street 2:PMB 1001
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-385-7041
Mailing Address - Fax:
Practice Address - Street 1:250 W ROUTE 66
Practice Address - Street 2:7
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-385-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty