Healthcare Provider Details

I. General information

NPI: 1902711278
Provider Name (Legal Business Name): AVISION THERAPY LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD # 188791
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD # 188791
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 310-595-7922
  • Fax:
Mailing address:
  • Phone: 310-595-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEVEN CARRON MITCHELL
Title or Position: PRESIDENT
Credential: LCSW
Phone: 310-595-7922