Provider Demographics
NPI:1679268668
Name:SERENITY FAMILY THERAPY INC.
Entity type:Organization
Organization Name:SERENITY FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GRISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELAUF
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-649-3863
Mailing Address - Street 1:5015 CANYON CREST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6006
Mailing Address - Country:US
Mailing Address - Phone:909-649-3863
Mailing Address - Fax:
Practice Address - Street 1:5015 CANYON CREST DR STE 105
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6006
Practice Address - Country:US
Practice Address - Phone:909-649-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty