Healthcare Provider Details

I. General information

NPI: 1659861052
Provider Name (Legal Business Name): CENTER FOR HEALTHY AND HAPPY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 VENTURA BLVD STE 1208
SHERMAN OAKS CA
91403-2271
US

IV. Provider business mailing address

PO BOX 17144
ENCINO CA
91416-7144
US

V. Phone/Fax

Practice location:
  • Phone: 424-274-2256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIKA KORMEILI
Title or Position: LMFT
Credential: LMFT
Phone: 424-274-2256