Healthcare Provider Details

I. General information

NPI: 1558909960
Provider Name (Legal Business Name): SELF CARE COUNSELING MARRIAGE FAMILY AND CHILD THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 W SUNSET BLVD STE 400
LOS ANGELES CA
90026-3262
US

IV. Provider business mailing address

1910 W SUNSET BLVD STE 400
LOS ANGELES CA
90026-3262
US

V. Phone/Fax

Practice location:
  • Phone: 213-347-4740
  • Fax: 818-476-7206
Mailing address:
  • Phone: 213-347-4740
  • Fax: 818-476-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LUZ ELENA FLORES
Title or Position: MFT/OWNER
Credential: MFT
Phone: 213-347-4740