Healthcare Provider Details

I. General information

NPI: 1558390641
Provider Name (Legal Business Name): THE GREENLEAF CENTER A PSYCHOLOGICAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13006 PHILADELPHIA ST SUITE 411
WHITTIER CA
90601-4210
US

IV. Provider business mailing address

13006 PHILADELPHIA ST SUITE 411
WHITTIER CA
90601-4210
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-5108
  • Fax: 562-945-5208
Mailing address:
  • Phone: 562-945-5108
  • Fax: 562-945-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16485
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC41879
License Number StateCA

VIII. Authorized Official

Name: DR. JORGE GARCIA
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 562-945-5108