Healthcare Provider Details

I. General information

NPI: 1780269233
Provider Name (Legal Business Name): NASABA CHILDREN & FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S SPRING ST UNIT 13308 13024
LOS ANGELES CA
90013-3215
US

IV. Provider business mailing address

506 S SPRING ST UNIT 13308 13024
LOS ANGELES CA
90013-3215
US

V. Phone/Fax

Practice location:
  • Phone: 310-848-5266
  • Fax:
Mailing address:
  • Phone: 310-848-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN GARRETT
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 310-848-5266