Healthcare Provider Details

I. General information

NPI: 1497336432
Provider Name (Legal Business Name): GUIDING OUR YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 CASARIN AVE
SIMI VALLEY CA
93065-4515
US

IV. Provider business mailing address

1197 E LOS ANGELES AVE # C-338
SIMI VALLEY CA
93065-2868
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-4891
  • Fax:
Mailing address:
  • Phone: 818-395-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARAL PUSHIAN SULTANIAN
Title or Position: HEAD OF SERVICE
Credential: PHD, LMFT
Phone: 805-296-8677