Healthcare Provider Details

I. General information

NPI: 1962077644
Provider Name (Legal Business Name): COLLEGE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 H ST
BAKERSFIELD CA
93301-1913
US

IV. Provider business mailing address

4821 KATELLA AVE SUITE 201
LOS ALAMITOS CA
90720
US

V. Phone/Fax

Practice location:
  • Phone: 661-546-6365
  • Fax:
Mailing address:
  • Phone: 661-546-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: AMY DIANE SANCHEZ
Title or Position: MFT TRAINEE
Credential:
Phone: 661-546-6367