Healthcare Provider Details

I. General information

NPI: 1780233478
Provider Name (Legal Business Name): CONSCIOUSLY EVOLVED FAMILY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 TOWNSGATE RD STE 150
WESTLAKE VILLAGE CA
91361-5724
US

IV. Provider business mailing address

PO BOX 1091
THOUSAND OAKS CA
91358-0091
US

V. Phone/Fax

Practice location:
  • Phone: 805-307-7933
  • Fax:
Mailing address:
  • Phone: 805-574-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH MARIE SCHIMPFF
Title or Position: PRESIDENT
Credential: LMFT
Phone: 805-574-9217