1467859595 NPI number — SERENITY FAMILY AND PSYCHOLOGICAL COUNSELING CENTER, P.C.

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 1467859595 NPI number — SERENITY FAMILY AND PSYCHOLOGICAL COUNSELING CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY FAMILY AND PSYCHOLOGICAL COUNSELING CENTER, P.C.
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:
1467859595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 ALMA REAL DR
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
PACIFIC PALISADES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90272-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-310-9249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
881 ALMA REAL DR
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
PACIFIC PALISADES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90272-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-310-9249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MEDNICK
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
310-310-9249

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  36644 , 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)

  • Identifier: 1114268497 . This is a "SERENITY TRAUMA HEALING CENTER INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295076578 . This is a "JOANNE GAIL MEDNICK LMFT 36644" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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