Healthcare Provider Details

I. General information

NPI: 1134771447
Provider Name (Legal Business Name): COUNSELING RESOURCE AND EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21151 S WESTERN AVE STE 146
TORRANCE CA
90501-1724
US

IV. Provider business mailing address

21151 S WESTERN AVE STE 146
TORRANCE CA
90501-1724
US

V. Phone/Fax

Practice location:
  • Phone: 424-271-7778
  • Fax: 888-792-6665
Mailing address:
  • Phone: 424-271-7778
  • Fax: 888-792-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY HANDY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 562-310-9215