Healthcare Provider Details

I. General information

NPI: 1295967693
Provider Name (Legal Business Name): EMOTIONAL HEALTH ASSOCIATION SHARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S BROADWAY
LOS ANGELES CA
90013-1102
US

IV. Provider business mailing address

425 S BROADWAY
LOS ANGELES CA
90013-1102
US

V. Phone/Fax

Practice location:
  • Phone: 213-213-0100
  • Fax:
Mailing address:
  • Phone: 213-213-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DAVID ULF
Title or Position: CEO
Credential: BA
Phone: 310-846-5270