Healthcare Provider Details

I. General information

NPI: 1508402363
Provider Name (Legal Business Name): COLDWATER COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 COLDWATER CANYON AVE STE E
STUDIO CITY CA
91604-1478
US

IV. Provider business mailing address

20301 VENTURA BLVD STE 214
WOODLAND HILLS CA
91364-0932
US

V. Phone/Fax

Practice location:
  • Phone: 818-508-0703
  • Fax: 818-508-0703
Mailing address:
  • Phone: 818-508-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GALIPEAU
Title or Position: PRESIDENT
Credential: LMFT
Phone: 818-508-0703