Healthcare Provider Details

I. General information

NPI: 1669757597
Provider Name (Legal Business Name): STARVIEW ADOLESCENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 WEST 226TH STREET
TORRANCE CA
90505
US

IV. Provider business mailing address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-4556
  • Fax:
Mailing address:
  • Phone: 310-373-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101YM0800X
License Number StateCA

VIII. Authorized Official

Name: MR. MIGUEL ANGEL GARCIA
Title or Position: TBS COUNSELOR
Credential:
Phone: 310-373-4556