Healthcare Provider Details

I. General information

NPI: 1023650801
Provider Name (Legal Business Name): HENRY N HOBDY PEER SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 W 54TH ST
LOS ANGELES CA
90062-2604
US

IV. Provider business mailing address

1873 W 54TH ST
LOS ANGELES CA
90062-2604
US

V. Phone/Fax

Practice location:
  • Phone: 323-331-5678
  • Fax: 310-349-3660
Mailing address:
  • Phone: 323-331-5678
  • Fax: 310-349-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: