Healthcare Provider Details

I. General information

NPI: 1669887238
Provider Name (Legal Business Name): INSTITUTE FOR MULTICULTURAL COUNSELING AND EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010-2501
US

IV. Provider business mailing address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010-2501
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-4803
  • Fax:
Mailing address:
  • Phone: 213-383-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number960000918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number960000918
License Number StateCA

VIII. Authorized Official

Name: DR. TAHEREH PIRHEKAYATY
Title or Position: CEO
Credential:
Phone: 213-383-4803