1356880462 NPI number — ACORN FAMILY GUIDANCE CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356880462 NPI number — ACORN FAMILY GUIDANCE CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACORN FAMILY GUIDANCE CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
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:
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:
1356880462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12777 W JEFFERSON BLVD
Provider Second Line Business Mailing Address:
BUILDING D, SUITE 300
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90066-7048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-289-2725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12777 W JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
BUILDING D, SUITE 300
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-7048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-289-2725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LAUE
Authorized Official First Name:
CARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL CHILD PSYCHOLOGIST
Authorized Official Telephone Number:
424-289-2725

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PSY28903 , 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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