Healthcare Provider Details

I. General information

NPI: 1396601167
Provider Name (Legal Business Name): ENVISION YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 LONG BEACH BLVD STE 136
LONG BEACH CA
90805-5858
US

IV. Provider business mailing address

5378 LONG BEACH BLVD STE 136
LONG BEACH CA
90805-5858
US

V. Phone/Fax

Practice location:
  • Phone: 562-519-9657
  • Fax: 562-519-9657
Mailing address:
  • Phone: 562-519-9657
  • Fax: 562-519-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAMELAH THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 562-519-9657