Healthcare Provider Details

I. General information

NPI: 1154649564
Provider Name (Legal Business Name): D'VEAL FAMILY AND YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 LINCOLN AVE
PASADENA CA
91103-1315
US

IV. Provider business mailing address

PO BOX 40255
PASADENA CA
91114-7255
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5600
  • Fax:
Mailing address:
  • Phone: 626-296-8900
  • Fax: 626-296-8910

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: MR. JOHN T. MCCALL
Title or Position: CEO/D'VEAL FAMILY & YOUTH SERVICES
Credential: LCSW
Phone: 626-794-3136