Healthcare Provider Details

I. General information

NPI: 1407923642
Provider Name (Legal Business Name): SUMA SEELAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 120TH ST
LOS ANGELES CA
90059-3052
US

IV. Provider business mailing address

414 S SANTA ANITA AVE #2
ARCADIA CA
91006-3505
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW17860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: