1982737425 NPI number — SOUTH CENTRAL TRAINING CONSORTIUM, INC.

Table of content: KAITLYN SCOTT MCGURN LMHC (NPI 1821551540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982737425 NPI number — SOUTH CENTRAL TRAINING CONSORTIUM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL TRAINING CONSORTIUM, INC.
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:
1982737425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5022 W AVENUE N STE 102-21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-5757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-943-3708
Provider Business Mailing Address Fax Number:
661-349-4633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5022 W AVENUE N STE 102-21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-5757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-943-3708
Provider Business Practice Location Address Fax Number:
661-349-4633
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
BRINKLEY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
661-943-3708

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  1876925 , 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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