1275937682 NPI number — EMMONS STUDENT WELLNESS CENTER

Table of content: MS. DEBBIE TANTRUM MA, LMHC (NPI 1750691515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275937682 NPI number — EMMONS STUDENT WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMMONS STUDENT WELLNESS CENTER
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:
1275937682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 CAMPUS RD # F-57
Provider Second Line Business Mailing Address:
EMMONS WELLNESS CENTER
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90041-3314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-259-2657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CAMPUS RD # F-57
Provider Second Line Business Practice Location Address:
EMMONS WELLNESS CENTER
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90041-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-259-2657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SEMAL
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR
Authorized Official Telephone Number:
323-259-2657

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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