Healthcare Provider Details

I. General information

NPI: 1225374069
Provider Name (Legal Business Name): PACIFIC ASIAN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD STE 200
LOS ANGELES CA
90045-3945
US

IV. Provider business mailing address

4427 W 138TH ST # A
HAWTHORNE CA
90250-6909
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-1550
  • Fax:
Mailing address:
  • Phone: 310-531-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number171M00000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number171M00000X
License Number StateCA

VIII. Authorized Official

Name: JOYCELYN MANZANO
Title or Position: HR
Credential:
Phone: 310-337-1550