Healthcare Provider Details

I. General information

NPI: 1558207449
Provider Name (Legal Business Name): RAISING CONSCIOUSNESS FAMILY THERAPY, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 ALTA VISTA RIDGE RD
SANTA SUSANA CA
93063-4745
US

IV. Provider business mailing address

6363 ALTA VISTA RIDGE RD
SANTA SUSANA CA
93063-4745
US

V. Phone/Fax

Practice location:
  • Phone: 805-669-1263
  • Fax:
Mailing address:
  • Phone: 805-669-1263
  • 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: MRS. KRISSELLA LEE GLENNON-BOATRIGHT
Title or Position: CEO, PRESIDENT
Credential: LMFT #162992
Phone: 805-663-1263