Healthcare Provider Details

I. General information

NPI: 1730688391
Provider Name (Legal Business Name): TOTAL CARE MANAGEMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 NATIONAL BLVD STE 253
LOS ANGELES CA
90064-4178
US

IV. Provider business mailing address

214 MAIN ST # 272
EL SEGUNDO CA
90245-3803
US

V. Phone/Fax

Practice location:
  • Phone: 310-341-9512
  • Fax:
Mailing address:
  • Phone: 310-341-9512
  • Fax: 310-616-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number76411
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number76411
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76411
License Number StateCA

VIII. Authorized Official

Name: CHELSEA CANNING
Title or Position: CEO
Credential: LCSW
Phone: 310-341-9512