Healthcare Provider Details

I. General information

NPI: 1831590942
Provider Name (Legal Business Name): SOCAL CHILD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5195 LINDLEY AVE
TARZANA CA
91356-4349
US

IV. Provider business mailing address

PO BOX 931774
LOS ANGELES CA
90093-1774
US

V. Phone/Fax

Practice location:
  • Phone: 818-804-0322
  • Fax:
Mailing address:
  • Phone: 917-517-7347
  • 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: GISELLE LOUISE JONES
Title or Position: THERAPIST
Credential: ASW
Phone: 917-517-7347