Healthcare Provider Details

I. General information

NPI: 1801556063
Provider Name (Legal Business Name): JUNGLEMANIA FAMILY SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 PHILADELPHIA ST
WHITTIER CA
90601-3900
US

IV. Provider business mailing address

11721 WHITTIER BLVD # 149
WHITTIER CA
90601-3939
US

V. Phone/Fax

Practice location:
  • Phone: 562-567-7417
  • Fax:
Mailing address:
  • Phone: 562-567-7417
  • Fax:

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: JESSICA PEREZ
Title or Position: CEO
Credential: LCSW
Phone: 562-567-7417