1235268194 NPI number — COMMUNITY COUNSELING FOR INDIVIDUALS AND FAMILIES

Table of content: (NPI 1235268194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235268194 NPI number — COMMUNITY COUNSELING FOR INDIVIDUALS AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY COUNSELING FOR INDIVIDUALS AND FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235268194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27162 SEA VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALIBU
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90265-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-457-9958
Provider Business Mailing Address Fax Number:
310-457-8442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-472-3728
Provider Business Practice Location Address Fax Number:
310-472-9960
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RADANT
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
310-472-3728

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  13192 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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