Healthcare Provider Details

I. General information

NPI: 1811504970
Provider Name (Legal Business Name): HIDDDDEN NO MORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 S SEPULVEDA BLVD STE 410
LOS ANGELES CA
90045-3634
US

IV. Provider business mailing address

8929 S SEPULVEDA BLVD STE 410
LOS ANGELES CA
90045-3634
US

V. Phone/Fax

Practice location:
  • Phone: 424-317-6800
  • Fax: 877-219-8239
Mailing address:
  • Phone: 424-317-6800
  • Fax: 877-219-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WENDY T TALLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: DSW, LCSW
Phone: 424-317-6800