1689082067 NPI number — VALLEY COUNSELING AND WELLNESS CENTER

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 1689082067 NPI number — VALLEY COUNSELING AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY COUNSELING AND 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:
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:
1689082067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14724 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 1100
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91403-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-622-8176
Provider Business Mailing Address Fax Number:
818-986-0724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14724 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-622-8176
Provider Business Practice Location Address Fax Number:
818-986-0724
Provider Enumeration Date:
07/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
626-622-8176

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  LCS 17117 , 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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