Healthcare Provider Details

I. General information

NPI: 1629445051
Provider Name (Legal Business Name): UNITED STATES VETERANS INITIATIVE - INGLEWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 HINDRY AVE
INGLEWOOD CA
90301-3030
US

IV. Provider business mailing address

800 W 6TH ST STE 1505
LOS ANGELES CA
90017-2742
US

V. Phone/Fax

Practice location:
  • Phone: 310-744-6552
  • Fax: 310-645-2605
Mailing address:
  • Phone: 213-760-4630
  • Fax: 310-645-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190188AN
License Number StateCA

VIII. Authorized Official

Name: DR. KIMBERLEY COOK
Title or Position: V.P. CLINICAL SERVICES
Credential: PSYD
Phone: 808-291-8198