Healthcare Provider Details

I. General information

NPI: 1558999151
Provider Name (Legal Business Name): TRIUMPH FAMILY WELLNESS COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 STOCKER ST STE 102
VIEW PARK CA
90008-5145
US

IV. Provider business mailing address

1850 WHITLEY AVE APT 301
LOS ANGELES CA
90028-4991
US

V. Phone/Fax

Practice location:
  • Phone: 424-274-1283
  • Fax:
Mailing address:
  • Phone: 424-274-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANTHONY MARIO SYKES
Title or Position: CEO
Credential: LMFT
Phone: 424-273-1283