Healthcare Provider Details

I. General information

NPI: 1497135214
Provider Name (Legal Business Name): LEARNING TREE THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E VISTA HERMOSA ST
LONG BEACH CA
90815-3932
US

IV. Provider business mailing address

12371 LEWIS ST 202
GARDEN GROVE CA
92840-4678
US

V. Phone/Fax

Practice location:
  • Phone: 714-697-3700
  • Fax:
Mailing address:
  • Phone: 714-697-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP16142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSP16142
License Number StateCA

VIII. Authorized Official

Name: MRS. KRISTEN CARTER
Title or Position: SPEECH PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 714-697-3700