Healthcare Provider Details

I. General information

NPI: 1023147139
Provider Name (Legal Business Name): D'VEAL FAMILY & YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD SUITE 230, 240, 250, 260
PASADENA CA
91107-1448
US

IV. Provider business mailing address

2750 E WASHINGTON BLVD SUITE 230 AND 240
PASADENA CA
91107-1448
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax: 626-405-8973
Mailing address:
  • Phone: 626-296-8900
  • Fax: 626-405-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW11363
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN TERRY MCCALL
Title or Position: CEO/D'VEAL FAMILY & YOUTH SERVICES
Credential: LCSW
Phone: 626-296-8900