Healthcare Provider Details

I. General information

NPI: 1083530596
Provider Name (Legal Business Name): PHOENIX HOUSE CALIFORNIA - LAKE VIEW TERRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 800-686-3000
  • Fax:
Mailing address:
  • Phone: 800-686-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JORDAN HOUSE GOLDSTEIN
Title or Position: MARRIAGE & FAMILY THERAPIST
Credential: AMFT
Phone: 657-270-4960