Healthcare Provider Details

I. General information

NPI: 1679937627
Provider Name (Legal Business Name): THELESE CONSULTING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 S. SEPULVEDA BLVD SUITE 400
LOS ANGELES CA
90045
US

IV. Provider business mailing address

8929 S. SEPULVEDA BLVD SUITE 400
LOS ANGELES CA
90045
US

V. Phone/Fax

Practice location:
  • Phone: 424-317-6800
  • Fax: 877-219-8239
Mailing address:
  • Phone: 424-317-6800
  • Fax: 877-219-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number25988
License Number StateCA

VIII. Authorized Official

Name: DR. WENDY THELESE TALLEY
Title or Position: FOUNDER/CEO
Credential: DSW, LCSW
Phone: 424-317-6800