Healthcare Provider Details

I. General information

NPI: 1932016565
Provider Name (Legal Business Name): SELF DETERMINED FUTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18726 S WESTERN AVE STE 415
GARDENA CA
90248-3858
US

IV. Provider business mailing address

18726 S WESTERN AVE STE 415
GARDENA CA
90248-3858
US

V. Phone/Fax

Practice location:
  • Phone: 562-335-7867
  • Fax:
Mailing address:
  • Phone: 562-335-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: EBONY MONTGOMERY
Title or Position: CEO
Credential: MBA
Phone: 562-335-7867