Healthcare Provider Details

I. General information

NPI: 1134356694
Provider Name (Legal Business Name): D'VEAL FAMILY AND YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2750 E WASHINGTON BLVD # 240250
PASADENA CA
91107-1448
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCS11363
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN T MCCALL
Title or Position: CEO
Credential: LCSW
Phone: 626-794-3136